The Assembly met at 10.30 am (The Initial Presiding Officer (The Lord Alderdice of Knock) in the Chair).
Members observed two minutes’ silence.

Presiding Officer’s Business

Lord Alderdice: By virtue of paragraph 1 of the schedule to the Northern Ireland (Elections) Act 1998, it falls to the Secretary of State to determine where meetings of the Assembly shall be held and when. I have received from the Secretary of State a letter directing that the Assembly shall meet at Parliament Buildings, Stormont at 10.30 am on Monday 14 December until 6.00 pm on Tuesday29December.
Members will appreciate from the Order Paper that it is unlikely that we could complete the business in one day. I have therefore indicated that this will be a two-day sitting of the kind referred to in draft Standing Order No 12.
It may be helpful if I clarify in advance how I intend to rule on the timing of any amendments, as referred to in the initial Standing Orders, which require amendments to be lodged
"at least one hour prior to the commencement of the day’s business".
If there are any amendments, I shall rule that lodgement will be required not one hour prior to commencement of the business on the Order Paper but prior to "the day’s business".
As this is a two-day sitting, I will treat each day separately. That means that any amendments for today’s business should have been lodged by 9.30 this morning, and any amendments for tomorrow’s business must be lodged with my office before 9.30 tomorrow morning.
During the course of business today, tomorrow and in the future, Members may see me using headphones when Irish is being spoken. This is to provide me with an English translation so that I can fulfil my function of ensuring that all contributions, whether in English or in Irish, conform to the rules of the Assembly. The facility is available only to me and the Clerks. It does not pre-empt a decision on the question of simultaneous translation facilities for Members. That will be a matter for the Committee on Standing Orders and for the Assembly.
I intend to use Erskine May for guidance on matters which arise during business in the Assembly or other matters on which I am asked to give a ruling and where the Initial Standing Orders and the draft Standing Orders are not clear or are insufficient.
At the Assembly sitting on 9 November 1998 a Member expressed concern about the accuracy of the Official Report of the proceedings of 26October1998 in respect of a speech by another Member. I conducted a full, formal investigation. I interviewed those concerned, including the Editor of Debates, and reviewed the video recording and the notes made by Hansard staff. I am satisfied that the Official Report, as published, gives a proper account of the speech in question.

Natural Gas (Areas Outside Greater Belfast)

Motion made:
To call attention to the lack of provision of a natural gas pipeline outside the Greater Belfast area; and to move for papers. — [MrADoherty]

Mr Arthur Doherty: There is an apparent lack of will in certain circles to correct this inequitable situation.
"Oh, East is East, and West is West, and never the twain shall meet".
That appears to be the philosophy that has directed so much of the strategic planning and regional development and which has brought Northern Ireland to its present confused condition. The signs are widespread, and the results are unfortunate, to say the least. Rail links have disappeared or been allowed to run to seed. A rail journey from Derry to Belfast is a depressing and lengthy ordeal. Motorways radiate in all directions from Belfast but come to a sudden halt after 20 or 30 miles. A motorist leaving Northern Ireland’s second city has to drive up to 50miles before reaching a motorway. This could not happen in any other part of Western Europe.
We who live in the north or the west have to be content with an odd half-mile or so of dual carriageway or with a promise that in 10 or 20 years, if we behave ourselves, we will have a bypass or, in the case of Strabane, half of a bypass. The only power station in the whole north-west sector of this island is under sentence of death in the name of progress.
That is just a taste of a condition that has been allowed to develop or even, some might say, actively promoted for a long time. The consequence of this infrastructure deficit, and of other factors that do not need to be stated here, is that a very large part of the north and west of Northern Ireland is seriously and unjustifiably disadvantaged. In respect of unemployment, poor health, poverty and social need, the constituencies and council districts of the north and west regularly come bottom, or close to bottom, of the list.
If inward investment happens, it is in spite of the existing infrastructure and some inertia in high places. It is more often the result of the efforts of dedicated individuals or bodies that have consistently promoted the talents, skills and energies of people who have proved time and time again that, in spite of political turmoil, violence and neglect, they can match the best if given the chance.
We are entering a new era of equality, equity, fairness and level playing fields. Northern Ireland is rising like a phoenix from the ashes — and the simile is deliberate. On the television set we see advertisements from a certain company extolling the virtues — efficiency, environmental friendliness and cost — of natural gas for homes and factories. What we are not told is that natural gas, with all its benefits of cost, cleanliness and efficiency, is not for us. The best we can expect is that we will be provided with more overpriced electricity — which we do not need — from an expensive, distant source.
Equality — how are you? Fairness — cad é mar a tá tú? Level playing field — hoo aboot yeh ?
The exclusion of so much of Northern Ireland from the benefits of a natural gas supply raises serious questions of equity. If this persists it will cast doubts on the Government’s sincerity in declaring their concern about targeting areas of social need. This need will not be satisfied by the implementation of proposals to import electricity to Northern Ireland by way of a Scottish interconnector. People better informed than I have called this an anachronism. The reasons put forward to justify it are like John Cleese’s parrot — gone, dead, passed on, obsolete, defunct, over and done with. Would that it were, for it is a non-project.
Unfortunately, the dead parrot is being resurrected. The unnecessary project has been given the kiss of life by a British Minister — whoever pulls his strings — and revived by a Labour Minister whose argument is that market forces will bring prices down. All things being equal, that might be so. However, all things are not equal.
I hoped that we could have this debate before the recent announcement about the interconnector. That did not happen, and it is now all the more important that the Assembly and the country be made aware of the likely consequences. We must look this gift horse in the mouth very closely. There will be a slight reduction in the price of electricity — but at what cost? It is virtually copperfastening the inequity of the present situation.
Coolkeeragh, which as a natural gas power station could produce cheaply all the power we need, may be allowed to die. Industries, which for the first time could compete on almost equal terms, will suffer continuing injustice, and a large part of the North of Ireland will be left to wither while others prosper. That is too high a price to pay for a drop of imported Scotch.
Having made the announcement about the interconnector and received a measure of support for it from some quarters, the Government may be happy to rest on their laurels, but they must not be allowed to do so, for Government laurels are all too often a bed of thorns.
There are very convincing economic and environmental reasons for extending gas provision. I have already mentioned the Coolkeeragh power station, which, if converted to use natural gas, would provide a substantial, anchored client base that would greatly improve the viability of the project.
The Government make much of the necessity to target areas of social need and of the need for policy appraisal and fair treatment. I would like to think that they are doing more than paying lip-service to those ideals. Up until now there has been little evidence of this in their reaction. A Cabinet study examined the question of wider provision of natural gas, but its brief was very narrow, being limited to consideration of the commercial feasibility of such an enterprise, and it concluded that without public funding it would not attract much interest from a commercial operator. I, with no commercial or business experience, could have said that.
Government intervention is essential. Before proceeding further, the Government must carry out a comprehensive cost-benefit and socio-economic analysis that is wider in scope than the Caninus study — an analysis that takes account of all factors: economic, environmental, energy, equity and social need.
The absence of provision for gas puts a considerable section of Northern Ireland at a serious disadvantage in terms of attracting inward investment. Many established industries cannot compete on equal terms with more favoured eastern industries. Those living in regions with the highest level of social deprivation, with the highest unemployment and the lowest per-capita income, suffer further from having the most expensive fuel. It is not unreasonable to demand that the needs of less favoured areas in Northern Ireland be met in spite of the financial cost.
According to the Caninus study, commercial operators would put profits before philanthropy, but there are very strong reasons for the Government to show wider concern and subsidise the extension of natural gas beyond the Greater Belfast area. It is common world-wide for gas and other pipelines to be heavily supported by Governments. That is what happened with the pipeline from Scotland to Larne, and the gas network in Greater Belfast has benefited from EU grant aid. One argument for an extended pipeline is the recognised environmental, social and economic benefit that would be brought to an area which accounts for one fifth of the region’s population.
I close by drawing the Assembly’s attention to the commendable work of Group 22. Group22 is a partnership of district councils along the northern corridor stretching from Ballymena, through Ballymoney, the Coleraine triangle area, Moyle, Limavady, Derry and Strabane to Donegal. The partnership also includes business, industry and community interests. It transcends all divisions and is united in its determination to pursue this matter to a successful conclusion. It is supported by Northern Ireland’s three MEPs and leading economists and has enjoyed the encouragement of OFREG.
We expect a similar partnership of the various interest groups in the Assembly to act jointly and with determination on a matter which affects the well-being and the economic survival of a substantial proportion of the population across all social and political divides.

Mr David McClarty: As an elected representative of East Londonderry I am perturbed by the lack of provision for a natural gas pipeline outside the Greater Belfast area.
The big argument, of course, is that it would not be economically viable for the rest of the Province to be served without subvention. But it was not economically viable to bring the pipeline to Northern Ireland in the first place without subvention.
The Government Paper ‘Shaping Our Future’ stresses the importance of developing the northern corridor. Such development must obviously include economic development, and without the provision of natural gas to the north-west, the people there will be seriously disadvantaged as industry moves to where energy is cheapest. The supply of gas to the northern corridor is inextricably linked to the future of Coolkeeragh power station. Coolkeeragh will close between 2002 and 2004. Given the time necessary for planning and constructing a pipeline, it is clear that the decision on any future generation activity at Coolkeeragh cannot be delayed much longer.
If a new station is to be constructed, it is critical that a decision on the extension of the gas network to the north and north-west be made now. The decisions about the gas pipeline and the power station depend on one another, and I urge those with influence to reach those decisions at the earliest possible date.
Many of Northern Ireland’s unemployment black spots are in the north and the north-west, and without the provision of natural gas the situation can only worsen. The area I represent is happy to compete with any other area for inward investment, but the competition must be on an equal footing so that we in the north and the north-west are not seriously disadvantaged.
I wholeheartedly support the motion.

Mr William Hay: I support what has been said by Mr A Doherty and Mr McClarty, who represent East Londonderry. As a Member for Foyle and Londonderry, I come from an area which is socially deprived — indeed, it has the highest unemployment in Northern Ireland.
It is a pity that the Minister is not here for this debate. If he had taken all the issues on board, the decision on the Scottish interconnector would not have been made. So many Ministers are leaving so much to the Assembly that one wonders why he did not leave this decision to us.
Everybody knows the history of natural gas coming to Northern Ireland. It was very much decided by Europe and, of course, by the Government. Europe has provided almost £45 million, and the Government £14million.
I want to thank Group 22, for it is the engine that has driven this matter forward. Natural gas in the north and the north-west would affect 300,000 people. It is sad that only after Group 22, which represents eight councils in Northern Ireland and a wide range of businesses in the north and north-west, and after a group of industrialists had submitted a report, did the Minister and Department of Economic Development decide to have a feasibility study carried out.
When one looks at how that study was initiated, one sees that the Northern Ireland Office broke every rule. Indeed, it even broke some European regulations when it decided to go ahead. The Northern Ireland Office looked only at the financial and economic implications; it did not look at the wider economic issues that the north and north-west of the Province will face if natural gas does not come.
At this moment the Government have no plans whatsoever to connect the rest of the Province to natural gas. But at least Group 22 has set the bandwagon rolling by getting them to produce this study. However, we all knew that the study, because its remit was so narrow, would tell us that it would not be economically viable to bring natural gas to the rest of the Province.
Unfortunately, only part of the report was made public. Part of it remains secret to this day, for whatever reason. It would have been interesting for the Members of the Assembly, as public representatives, to see the full report as Caninus, the company employed by the Government to conduct the economic reappraisal, initially stated that it would be important, both environmentally and financially, for natural gas to come to the north and north-west of the Province. However, Caninus was not allowed to consider the wider issues. This is clear when one examines the report.
The proposal to bring natural gas to the Province was supported by the eight relevant district councils represented here, by the three Northern Ireland MEPs and by several Members of Parliament. This is an issue that has cross-community support in the north and north-west of the Province, and it has the support of all the political parties. It is a voice that the Government cannot silence. It is important for economic, social, environmental and other reasons that natural gas come to the north and north-west.
It is very important that Group 22 be allowed to continue its work. The Department of Economic Development is currently considering a further Group 22 report, which answers some of the points raised in the report of the Department of Economic Development. I welcome this development and hope to see a very quick response to Group 22.
Another serious issue is the gradual rundown of Coolkeeragh power station, which is to close by the year 2004 when its contract runs out. I am afraid that Coolkeeragh will close before 2004. An important related issue is that of jobs. Although Coolkeeragh is being run down, no one in the plant knows exactly what is happening. Coolkeeragh is the only large power station in the north-west, yet the Department of Economic Development did not allow Caninus to look at the possibility of its being changed from oil to natural gas, as happened at Ballylumford — a change which was welcomed by everyone.
If Coolkeeragh were changed from oil to natural gas it could easily take 80% of the load that is coming through the pipes. Such a change was not considered by the study undertaken by the Department of Economic Development. It would probably take £73 million per year for the natural gas pipeline to be run from Belfast to the north and north-west.
One has to ask why the Department study did not consider all the main issues. Coolkeeragh could become the main beneficiary of natural gas coming to the north and north-west. Why did the Department not consult with the major industries and business people in the area? One can only assume that it was because of other issues.
It is important for the life of the power station, for the workers there and for the whole industry that the Government reconsider these matters and come up with ideas that have the support of Assembly Members. It is morally right that natural gas should come to the north and north-west of the Province, as well as to the Greater Belfast area.

Mr Mitchel McLaughlin: Go raibh maith agat, a Chathaoirligh. I reiterate my complete support for the comments of Colleagues in addressing this issue and in particular for the activities of Group 22 in bringing the matter before us.
The proposed natural gas line to the Greater Belfast area raises serious concerns which should engage the attention of Northern Ireland Office Ministers.
I am baffled as to how the decision could be justified in terms of social and economic disparities and against policy appraisal and fair treatment and targeting social needs criteria.
Do not the domestic consumers of the northern corridor have an equal right to gas-fired central heating and to cleaner fuel and cheaper energy? Clearly they do. Do not schools, hospitals, business, industry and manufacturing concerns in the north-west have the same absolute right as similar concerns in Greater Belfast? Clearly they do, and we must ask how this decision was taken.
Any region can suffer economic decline and deprivation, but disparities within regions, and particularly in a region as truncated as the Six Counties, are often a consequence of deliberate policy and practice. That must stop. If the peace process and the Assembly are about anything, they are about stopping practices which have created the disparities between regions that are less than 25 miles apart.
It is not an accident when proximate areas have widely varying statistics. Unemployment in some areas is among the lowest in Europe while 25 or 30 miles away there is a region with the highest of unemployment in western Europe. The disparity between the areas east and west of the Bann is so well documented that no one would attempt to deny it. There is an incontrovertible need for an end to programmes that have created such conditions.
Coolkeeragh power station will be closed in the next few years unless there is a change of policy on power generation and energy supply in the North. Coolkeeragh is coming to the end of its useful life, and it needs conversion and investment programmes. A decision to extend the natural gas pipeline to the north-west would provide both impetus and economic rationale for conversion to a gas-fired turbine generation plant. The future of the plant and that of the highly skilled workforce would be secure.
The options have not been fully explored, and there has been no credible explanation for that. The fact that a feasibility report has been kept secret fully justifies the concerns of my fellow Assembly Member for Foyle. There is no good reason for the Government not to share their political and economic intelligence on this matter. The issue is controversial. It is important for the north-west to have a level playing field that will enable us to help ourselves and rebuild the economy.
The case for the provision of a natural gas supply has been well made. The difficulty is that it has been made in a selective and preferential manner that will perpetuate the process of disadvantage between the areas east and areas west of the Bann. I welcome the cross-community and cross-party support for reversing that policy.
As well as proposing the delivery of a natural gas supply through the Greater Belfast area, we could consider the existence of a natural gas supply on this island. If we were to discuss the possibility of bringing both projects together we could address many of the concerns about the cross-border elements of economic strategy for the north-west region.
The Assembly should take the opportunity to call on the Minister to defer a definitive decision on the matter and to order a full, open and transparent reappraisal of all the options and report back to the Assembly. Fair play demands that. I hope that the Assembly will support Group 22 in its efforts; will support the workforce in Coolkeeragh; will support the communities in the northern corridor and the north-west; and will support links between east and west and between north and south — namely, a gas pipeline that has its conjunction in the north-west area.
The Assembly should make clear to the mandarins in the Northern Ireland Office and the civil servants responsible for this pernicious decision and for the policy which has affected the region for so long — that Members are not pleased and want the matter re-examined.

Mr David Ford: On behalf of the Alliance Party I welcome this motion. Perhaps the issue should have been discussed a few weeks ago, before Mr Ingram’s decision. However, I am pleased that Members are discussing it and that cross-party consensus has been achieved. For once, I agree with 90% of what Members have said, though it is a pity that they are all from the north and the north west. I believe that this project will have an impact beyond County Derry.
I am concerned that the Minister decided so speedily to proceed with the Scottish interconnector, just when a lobby seemed to be building up for other options to be looked at. Every other serious issue which has arisen in recent months has been "parked" by the appropriate Minister. The Assembly will have to decide on education reform, the future of health and personal social services, waste management and the regional plan, but this decision was rushed through as if it could not be left for the Assembly.
The decision may well be in the interests of power generators in Scotland, but I am unconvinced that the electricity interconnector is in the interests of people in Northern Ireland, especially those living in the most deprived areas.
Mr Doherty and others highlighted the interests of the north-west. In the context of this pipeline, let Members remember how far the north west extends. I represent South Antrim, which some people think is suburban, yet two thirds of South Antrim will not have natural gas under the current proposals.
If I have one criticism of Group 22 it is that they seem to have forgotten that Antrim also exists. It is the gap on the map between Belfast, where there is gas, and Ballymena, where they want to put it; Antrim is a fairly substantial town.
There is no doubt that the option to upgrade Coolkeeragh would ensure the viability of a pipeline for all of the north and north-west. I want to see both Derry and Letterkenny benefiting from the jobs which would be created, but I also want to see that benefit in Limavady, Coleraine, Ballymoney, Ballymena, Antrim and maybe even Ballyclare, depending on the route taken.
There was news last Friday of the potential loss of 1,000 jobs resulting from the takeover of Daewoo. The factories in Antrim and Carrickfergus are under threat. Therefore, when talking of the needs for economic development, Members must ensure the focus is not too narrow. Areas which are supposedly doing well also have considerable need.
In that context, the pipeline will benefit 20% of the population of Northern Ireland, not just the 10% who live in the north-west.
Mr Ingram’s decision to support the plan for an electricity interconnector will have three effects. It will damage the environment in east Antrim, which already has a higher than normal number of electricity pylons per acre; it will damage the economy, especially in the poorer areas of the north-west, but also in NorthernIreland as a whole; and it will undermine the whole idea of a strategic energy supply, for the whole Province will be relying on three sites situated within a few miles of each other — two in Islandmagee and one at Kilroot.
This decision does not represent the best economic option, for it will require a vast amount of EU funding. By contrast, the proposed gas pipeline to Derry would help to improve Coolkeeragh power station, would produce a real diversity of energy provision — certainly for NorthernIreland and, possibly, for the whole of the north of the island — would create jobs at Coolkeeragh and, indirectly in other industries, and would be less harmful to the environment.
Last week, the regional strategic plan was launched. Among the key objectives of this report are plans for the development of core centres. But this plan has undermined all of those objectives. People in Westminster and Whitehall spoke recently about "joined-up Government", but we seem to have the least joined-up Government imaginable. One Minister seems to be making a decision which totally contradicts the plans to be announced by one of his colleagues in a few weeks’ time. We will not have joined-up government until the Assembly takes on proper powers.
Mr Ingram has agreed to meet a delegation to discuss the Coolkeeragh option in a few weeks’ time. When he meets that group I hope that he will take the opportunity to remove his blinkers and look at the real energy needs of NorthernIreland.

Mr Robert McCartney: I fully support the motion. There should not be any difference in the supplies of fuel or energy to any part of NorthernIreland. My constituency of North Down could be seen as forming part of the Greater Belfast area. The extent of roadworks in the Holywood area suggests that that is where the pipeline is to be, and no doubt my constituents will benefit from it.
That does not prevent me from supporting the calls by those who represent other areas of the Province, particularly those with high unemployment where people need cheaper and more efficient forms of fuel, and where it would be beneficial to the local economic infrastructure to have cheaper and more efficient fuel supplies.
I wish that, when there is some cross-community consensus on an issue, some of the other parties would stop wallowing in paranoiac victimhood based on what has happened in the past. If the east of the Province traditionally had better levels of employment, it was because, during the 19th century, heavy industries, such as shipbuilding or the manufacture of equipment for the weaving and spinning industries, such as was carried out at Mackie’s factory, were all based in the areas of highest population density. It had little to do with whether communities were Nationalist or Unionist, but was based on the location of specific industries, the availability of imported steel, and other factors.
Let us stop wallowing in the past, rolling about in our victimhood and ascribing all sorts of natural and economic phenomena to some paranoiac vision of people plotting to disadvantage others. We should act together for the benefit of every citizen.
We should ensure maximum equality of treatment in the provision of both fuel facilities and services, but stop this nonsense of assigning them on the basis of some ancient wrong, some wound that must be kept open by being constantly picked at. We must start directing our minds to the most effective and efficient way of tackling the problems of the entire Province, regardless of nationality and political aspirations, and do the best we can.
We are now reaching the stage where, as in the past, so in the present, industry, big business and entrepreneurial activity are all dictating where certain operations are created and the areas they are intended to service. I have no doubt that the Greater Belfast area was chosen for natural gas because it has the highest concentration of people who can be serviced easily and quickly, and so it can provide the most efficient return to those investing in that business venture.
It is the Government’s function to control big business and operations such as this to ensure that they are not permitted purely to exploit that which brings the biggest profit and to ignore the social, economic, industrial and employment requirements of the entire Province.
For those reasons the Assembly must look after the interests of all the people of Northern Ireland. And in this regard, since this pipeline is coming into Belfast, I raise again the question of the Belfast port. I refute the suggestion that we can have improvements to our roads and transport system if we sell off the port at a cut price — once again, to entrepreneurs and businessmen who, behind the scenes, are already lining up substantial profits for themselves — regardless of whether it is in the best interests of the entire community.

Mr Sean Neeson: Mr McCartney has raised a very important point regarding the sale of Belfast harbour. Does he agree that it would be in the Assembly’s best interests to use researchers to put forward a case to counter the arguments of the Belfast Harbour Commissioners?

Mr Robert McCartney: I agree entirely with Mr Neeson’s suggestion and would be happy to participate in such an exercise.
The basic point of the motion is to ensure that we limit and control business and entrepreneurial exploitation of the Northern Ireland market over a range of matters — for example, supermarkets, the supply of gas, the supply of transport systems, the ports and the regulations that will control the rates to be paid on imported goods. We must do that on the basis of what is best for all the people of Northern Ireland and not on what, in immediate terms, serves the interests of the profiteers.

Mr James Leslie: At the risk of breaking up this very cosy and welcome cross-party consensus, I will introduce one or two caveats to the debate.
Mr Doherty stressed, quite rightly, the desirability of cheaper electricity, but that is not necessarily what we would get by extending the gas pipeline. We must look ahead a little on this subject.
Current estimates are that the United Kingdom will become a net importer of gas by 2010 at the latest. There are other sources of gas in Europe, but they are in places such as Siberia and Algeria where the level of political instability leaves our problems some way behind. I am not sure that we should put so many eggs into that particular basket. No significant finds of gas have been made around these islands, and that takes into account the drilling off the Skerries near Portrush.
Another fuel is readily available to us — lignite, or ‘green coal’. Members may not be surprised to learn that the main source of lignite is near Ballymoney, in my constituency. The key point is that the cost of generating electricity from lignite is about 2.7p per kilowatt, while the current average cost of electricity in Northern Ireland is about 4p per kilowatt. Extrapolated into the future, the supply of green coal is expected to last for at least 100 years. If we have to start buying gas from places further afield in Europe, we will have no real idea what the price is likely to be. We would be hooking into a source of fuel for our electricity whose price we could not control.
The proposal to open-mine green coal was made eight years ago by Nikitara Minerals. Originally it was looking for considerable Government assistance for the project, as is the case with the proposal for a north-west gas pipeline. However, the company recently formed a partnership that would allow it to finance the project itself. It is no longer looking for a subvention to get the project going.
Before privatisation, Northern Ireland Electricity’s stated aim was to generate electricity from one third oil, one third coal and one third lignite. Since privatisation, those parameters have been changed, and the proposal to use green coal has been dropped. The planned interconnector with Scotland actually enhances the argument for using green coal. In that situation, Nikitara Minerals could sell the excess electricity to the grid and it could be sold back to Scotland when Scotland has a supply shortage. There is a complementary circle in that method of providing electricity.
The other factor, which I think motivated Nikitara Minerals in its most recent proposal and in its joint venture with Meekatharra, is that from next year EU regulations will enforce a free market in electricity. Northern Ireland Electricity may find it more difficult to propagate its current cosy monopoly. Both Northern Ireland and the Republic of Ireland need more electricity; the supply is uneven. It is a question of when electricity needs to be pumped into the grid. An efficient grid is required so that electricity can be moved around.
One of the main objections to the opencast mining of green coal is environmental, and everyone needs to focus on the way in which environmental arguments are advanced. The environmental lobby has been very effective. Mineral extraction companies now know that they can no any longer get away with the slash and burn approach that they have pursued for many years. Environmental concerns are expected to be uppermost in their calculations, and they are constantly required to repair the damage that they have caused. When they finish, they have to leave the environment as good or better than it was when they found it.
This is entirely clear to Meekathurra Minerals. The firm knows that it cannot just lay waste to a huge swathe of land between Ballymoney and Stranocum and do nothing about it. It feels that it will be easily able to afford to replace the terrain and to blend in the area where there has been extraction with the natural environment. It would be ridiculous to grant it a licence to mine without very strict stipulations about that, and the firm expects that to be a part of the negotiations for its licence.
In the Moyle part of my constituency there is over 15% unemployment, and unless we get better weather or more tourists, this figure can only go up. We have just lost jobs, as have Members representing the Londonderry area, in the manufacturing sector. Unfortunately we are in a global market, and one of the key costs, apart from labour, is the supply of energy. It is critical that we find the best way of providing cheaper electricity on a lasting basis in order to preserve manufacturing jobs, wherever they may be.
It would be a great boost to the area that I represent to know that we had 1200 construction jobs for three years to build an electricity generating plant, and then in the region of 200 or 300 jobs to carry out the mining. That would enable us to provide a constant supply of electricity at a price which could be negotiated in such a way as to be fixed for a protracted period.
While the pipeline is worthy of detailed examination, and may well prove to be a worthwhile venture, the most pressing need at the moment is to find a method of providing cheaper electricity. And we could do that much more quickly, and at no cost to the public purse, if we were to give our support to Meekathurra Minerals to develop the green coal site in the Stranocum area.

Mr Eugene McMenamin: To enable us in West Tyrone and in the north-west to have a thriving society we must have proper infrastructure in place, and one priority is to have a choice of energy supply for industry and the domestic user.
I represent one of the most deprived areas in Northern Ireland, and we have to bring gas to the north-west, West Tyrone and Strabane in particular — the unemployment blackspot of the North of Ireland. We have to be able to offer any company setting up the option of gas or electric energy. That is why I am calling for gas for the north-west.
At the moment we, as taxpayers, are subsidising the Belfast area. For too long the people of the north-west have been treated as second-class citizens. Now, with proper representation within the Assembly, we will make sure that West Tyrone and the north-west get a fair share of the cake.
I support the motion.

Mr Gregory Campbell: I support the motion. Mr Leslie’s speech was an interesting diversion, but we need to come back to the real world and try to ensure that we have an adequate energy supply across the Province — and not only an adequate energy supply, but one that is within the reach of the entire community.
I want to dwell on two central issues. A number of people have mentioned the population that will be excluded if the interconnector and the gas pipeline reach only the Greater Belfast area. The numbers are approximately 300,000, about 20% of the population of Northern Ireland, which just happens to be approximately the population of the city of Belfast.
I do not contend that the population of Antrim, which, as Mr Ford has reminded us, is in the northern corridor, right through Ballymena, Ballymoney, Coleraine and Limavady to Londonderry is of the same density as that of the city of Belfast. Of course, it is not, but numerically it is roughly the same.
First, can you imagine the outcry if the city of Belfast were to be excluded from the provision of a natural gas pipeline? Of course, it would not be contemplated. Secondly, Members should put down a marker to the Minister regarding the rationale for this. If an interconnector were up and running and there were a marginal reduction in the price of electricity to all domestic and commercial consumers, that, of course, would be welcome.
The regulator, MrMcIldoon, has made a considerable effort to keep prices down, but obviously there are factors outside his remit that have prevented prices being reduced even further.
In addition, the Greater Belfast area would have an alternative energy supply — natural gas — which would be just as competitive. Many argue that it would be even more competitive. Inward investors would have an option.
We should not try to divide the Assembly. I and other Members who represent the north and the north-west do not decry the Greater Belfast area for getting a natural gas pipeline. It is commendable that that should happen, and as many people as possible should make use of it.
However, if the Greater Belfast area can provide inward investors not only with cheaper electricity but also with the option of cheaper gas, it follows that it will have an even greater commercial advantage.
If it is difficult to attract industry to, for example, Coleraine at present, it will be almost impossible to do so if there is an option to go to a location where a natural gas pipeline offers an even greater incentive.
Reference has been made to the document ‘Shaping our Future’, which I am sure the Assembly will analyse and pass judgement on. If that is used as the base, a natural gas pipeline is a prerequisite for places in the northern corridor such as Ballymena, Coleraine and Londonderry to prosper, improve economically and become viable units for the people who live there. But this cannot be done if an interconnector offers an unnatural disadvantage to only one segment of the population.
I support the motion and hope that, in the near future, Members can persuade the Minister to provide the wherewithal to extend a natural gas pipeline beyond the Greater Belfast area.

Mr Barry McElduff: A Cheann Comhairle, MrInitial Presiding Officer, Ba mhaith liomsa mo thacaíocht don rún seo a chur in-iúl. Is ábhar fíor-thábhachtach é seo, agus cuirim fáilte roimh an seans an díospóireacht a fhorbairt.
As a Member for West Tyrone, I commend this motion and add my voice to those arguing for the provision of natural gas to the north-west and to other areas outside Greater Belfast. I see the need for this debate to transcend the narrow confines of energy policy. Wider economic, social and equality arguments must be allowed to influence this decision-making process.
Sinn Fein believes that social and economic need must govern the decision. IvanBarr, the chairperson of Strabane District Council, contacted me about this on Friday, and he outlined how important it is to residents in that area also.
The north-west, which includes at least Derry, Strabane, Fermanagh, Omagh, County Donegal and Limavady, has long been characterised by social and economic disadvantage. Unemployment is comparatively high. The region scores badly on deprivation indicators across a spectrum of moral, social and economic variables, of which unemployment is one. It is not a figment of our imagination — and on that I take issue with MrMcCartney, who is not in the Chamber. The area suffers from a legacy of peripheral and economic discrimination, which was very real in the nineteenth century and has continued in the latter part of the twentieth century.
Ar an ábhar sin, tá fadhb an-mhór againn sna ceanntracha seo ó thaobh dí-fhostaíochta de, chomh maith le gnéithe sóisialta eile, agus caithfear rud éigin a dhéanamh faoi seo.
The proposal to extend the availability of natural gas to the north-west must be considered under agreed policy objectives such as targeting social need, cross-border co-operation and local economic development.
The stated priorities of TSN are to target resources on people and areas in greatest need, to reduce differentials, remove inequality and give people equal rights. The inequality between the north-west and the north-east would undoubtedly be increased if natural gas were confined to the Greater Belfast area. The former would suffer further disadvantage and peripherality if gas were made available only in Belfast.
There is a social and economic imperative and a direct connection between the availability of suitable energy supplies and the competitiveness of an area with regard to inward investment and economic development. Natural gas would certainly bring benefits to the north-west. It would enhance the area’s competitive position and help immeasurably towards creating real jobs.
However, if gas is not available the area will suffer decline in business and job numbers. It will be ruled out in terms of attracting some types of industry, particularly large energy users. The denial of a supply would place the north-west at an even bigger disadvantage in relation to other parts of the North and the island as a whole which have the benefit of gas. It would seriously reduce the area’s inward-investment performance — something that we can ill afford.
I have concentrated on social and economic need. If that matter is addressed, and if gas is made available, the domestic-energy user will enjoy substantial savings.
Other relevant factors include cross-border co-operation and the avoidance of duplication between Donegal and the part of the north-west to which I have referred, and which is located within the Six-County state. There is a real national, regional and European dimension to this matter. Alleviating the effects of peripherality, developing internal networks and an energy infrastructure, fulfilling EU funding criteria should not be ignored.
We need to act decisively on this matter. Coolkeeragh power station should become the cornerstone of a new integrated gas-to-electricity power project for the north-west. The benefits of that would be social, economic and environmental, and they would be national in character. Failure to extend the availability of natural gas would be viewed by many as a further act of inequality and discrimination. I call on everyone to support the motion.
Agus níor mhaith liom mórán eile a rá, ach amháin go mbaineann an cheist seo le comhionannas agus le cothrom na Féinne. Tá muidne dubh-dóite sna ceanntracha s’againne san iarthar agus sa tuaisceart de mhí-bhuntáistí agus easpa comhionannais. Tá athrú intinne agu athrú dearcaidh de dhíth orainn ó na h-údaráis, mar a thugtar orthu.

Mr Billy Bell: Mr Presiding Officer, you have a distinct advantage over the rest of us because you have that earpiece.
As a Member from the east of the Province, I support the motion. I am grateful to MrDoherty for raising the matter.
Unlike Mr McCartney, I have to refer to the past because the issue of a natural gas pipeline was initiated in the early 1970s and was ongoing throughout that time. For part of that period I was chairman of Belfast City Council gas committee. We attempted to persuade MrsThatcher’s Government to provide a gas pipeline from GreatBritain to NorthernIreland, but we were unsuccessful. This defeats the idea that Belfast was being favourably treated. As a consequence the rest of the Province was denied a pipeline as well.
The Government negotiated with the Irish Government to provide a pipeline from Kinsale to NorthernIreland. The idea was to bring it to Belfast first and then distribute it throughout the Province. Even though they had spent over £5 million in pipelaying from Dundalk up to the Border, the Government, without any notice, decided that that was going to be abandoned. Two or three weeks before it happened MrAdamButler looked across from Portstewart into the sunset and said "There is the new gasworks". A few weeks later that whole concept was abandoned.
At that time I was made Chairman of the Northern Ireland Gas Employers Board which represented all 13 of the gas undertakings in NorthernIreland, including the one in Derry. We formed an alliance with the trade union and produced our own plan. We proposed bringing natural gas from Kinsale into the Belfast area, to develop it there — because the population was there — and then to bring it to all other parts of the Province.
We had the finance in place, and all we asked from the Government was their blessing for the scheme. They did not give it. On another Good Friday, in 1985, they took the decision to close the gas industry down in spite of the fact that it took £250million to do so. The price of the pipeline was estimated at £50million so it cost them five times as much to close the pipeline than to build it.
I support the motion. As MrDoherty said, there are good economic and environmental reasons. People in NorthernIreland — who are part of the UnitedKingdom irrespective of which part they live in or whether they recognise it or not — ought to share in natural gas, which is a national asset.
The Minister’s decision is not good. The Assembly will have to address this issue at some stage because a decision to provide a pipeline to supply gas to all the people of NorthernIreland will have to be taken.

Lord Alderdice: The Member made reference to the use of headphones. The headphones are to ensure that what is said in the first instance bears some relation to the translation. I hope that Members will continue to observe the courtesy of providing their own translations.

Mr Billy Bell: I understand. I was speaking tongue-in-cheek.

Mr Billy Hutchinson: Are we on Eircell or Cellnet?

Lord Alderdice: I think we are on gas at present.

Mr John Dallat: It seems that gas has already been introduced into the Assembly.
Mr Bell’s history of the gas industry in Northern Ireland is correct. In the early 1970s NorthernIreland had a gas supply, and the relevance of that is very important today. It is important for the regeneration of all of the towns between Belfast and Derry and urgent in order to prevent the closure of Coolkerragh Power Station within a few years.
It is incomprehensible that we have to deal with arguments against a European grid which will deprive the rest of NorthernIreland of a natural gas pipeline. The disturbing news at the weekend that 2,000people are to lose their jobs at Fruit of the Loom and Desmonds, on both sides of the border in the north-west, makes this issue even more urgent and critical.
MrMcClarty and I recently represented Coleraine on a visit to several cities in the United States, and it became clear that towns and cities without a proper infrastructure, without a proper power supply, without proper roads, railways and airports et cetera, are not attractive to business and the availability of natural gas is an obvious prerequisite to enable the issue of equality to be addressed in the north-west.
We have been reprimanded for daring to refer to past neglect. However, it is important that history is not repeated. We have to learn from past mistakes so that they are not repeated and people are not marginalised or disadvantaged by accident or design either by Government policies or by the policies of the private sector, which is increasingly being called upon to provide the capital.
Natural gas is the power of the twenty-first century. There is no doubt about that. It is clean, economical and a key factor in decisions about industrial location. We cannot separate the economic and the social arguments. They go hand in hand and cannot be ignored. We have to target social need. The Assembly is right to debate this issue and to impress upon the Government and those charged with the provision of natural gas to the Greater Belfast area that they must not become a new body which will discriminate against people because of geographical location. The Assembly has an important role to play in imposing controls on the private sector whether over the supply of natural gas, the location of supermarkets, or any other critical aspects of life.
The arguments against the pipeline are not valid and they ignore the fact that large subsidies have already been provided to bring gas to NorthernIreland. Why not apply the same principles and bring gas to Coolkeeragh and to the other towns that have been mentioned this morning?
It would be a bad start for the Assembly if it were incapable of influencing the economic well-being of the north in a way which is seen to be just and fair. It is regrettable that decisions continue to be made without the Assembly’s having had the opportunity to consider them.
The provision of gas to the north and north-west would give some hope to those 2,000people who will become unemployed. It would attract new industries to replace those that are leaving. The supply of natural gas is essential — a must — and needs Government intervention now, not some time in the future.
Lignite and green coal can be discussed at any time, but this issue is critical: I believe that there is a move to ensure that the gas pipeline does not extend beyond the Greater Belfast area. That would be a major disappointment for Antrim, Ballymena, Ballymoney, Limavady, Derry, Strabane and Donegal.
References were made earlier to the Kinsale pipeline, which, sadly, did not come north. There is no reason for Ireland’s not having an integrated gas supply, for not finishing the work that was started in the 70s. We are part of Europe, and a fundamental principle is to create economic grids across Europe and beyond.
The social and economic considerations have been well highlighted here today. Reference has already been made to the important study carried out by Group 22. That study was welcome, and it was supported by every district council along the northern corridor, irrespective of politics.
I support the motion.

Mr Ian Paisley Jnr: I wish to congratulate MrDoherty for bringing this matter to the House. I welcome the debate and am glad that it has stimulated cross-party interest and support.
Mr McElduff’s earlier remarks reminded me of deprivation and other issues, including the occupied Six Counties, which he brought into the debate. I was reminded of GeorgesClemenceau’s comment to Lloyd George:
"I wish I could urinate as good as he speaks."
Some Members have introduced issues that are totally outside the remit of the debate.
The motion draws attention to the lack of natural gas provision outside the GreaterBelfast area. MrLeslie said earlier that he wished to inject some sanity into the debate. He failed because this is not a debate about cheaper forms of energy such as lignite. The debate is about the lack of a gas pipeline to parts of Northern Ireland outside the Greater Belfast area. Some Members believe, because the debate is about natural gas, that that gives them the opportunity to talk a lot of hot air. It does not and we should keep within the terms of the motion.
Those Members who have introduced other issues should perhaps declare their interest when it comes to talking about lignite and the development of land, especially in areas of Ballymoney.
The Government have facilitated the introduction of a natural gas network throughout the Greater Belfast area by issuing licences to Belfast Gas plc and to its subsidiary, Phoenix Natural Gas. By contrast, the Government have not outlined any plans for natural gas to be made available to areas outside Greater Belfast.
We have heard a lot about Group 22, which was formed over a year ago in response to the realisation that if people in the north, north-west and north-east did not get together they would be excluded from the decision-making process. We should look at what it would mean if those areas were excluded from the development of the gas pipeline. First, they have a population well in excess of 370,000 — more than 20% of NorthernIreland’s population — and encompass 27% to 30% of its land area. We would therefore be excluding a large proportion of the population from the benefits of natural gas.
I welcome MrFord’s comment that we should be looking at this matter much beyond the north and north-west areas. Members have said that it involves many other areas of the Province — indeed, it is about having equality throughout the Province. The people of the north-east and north-west have suffered badly in the past when they have been ignored prior to decisions being taken. Those people should be included when taking decisions about the future of NorthernIreland.
Many people have spoken about how the decision to stop natural gas from coming to these areas will result in further unemployment. In my constituency, Moyle has an unemployment rate of 14·7%, and when one combines the districts of Ballymena, Ballymoney and Moyle, one finds that these areas account for 6% of Northern Ireland’s unemployed.
It is clear that the unemployed have certain needs and deserve equality of treatment, and I hope it is realised that the exclusion of the north, north-east, the north-west and other areas of NorthernIreland from natural gas further disadvantages those people. The detrimental effects of the absence of gas in those areas will, of course, be compounded by its presence in GreaterBelfast.
We all have to ensure that the north, north-west and north-east do not become economic backwaters that are even more peripheral. Furthermore, existing local industries would be placed at a competitive disadvantage, the east coast corridor would be further enhanced, existing socio-economic differentials would be widened and substantial environmental benefits for this area would be lost.
How would the Government feel if they were a potential industrial investor in this part of Northern Ireland looking at the circumstances of that area? Would council areas such as Coleraine, Ballymena, Ballymoney or Antrim be able to attract investors on the same basis as Belfast or some of the council areas around the Greater Belfast area which will have natural gas? They would be unable to do so, and would therefore be further disadvantaged. We must move away from such a situation.
The absence of natural gas will have an adverse effect on local economic development, there will be a failure to promote local economic growth and an increase in unemployment. The area will become peripheral, and a level economic playing field will not exist.
12.00
There is a major thrust by the Confederation of Business Industry, IBEC and others to develop the Belfast-Dublin economic corridor. The Assembly should look at that proposal in conjunction with the proposal for the increase of natural gas to the rest of NorthernIreland. A sustained focus on the Belfast – Dublin economic corridor will further exacerbate the peripheral nature of the north, west, and border counties of the Province.
Members should be pulling together to work for Ulster instead of putting forward economic proposals for the betterment of the capital city and the east coast counties of the Republic of Ireland. Members should be working for the benefit of people in all areas of the Province including the Greater Belfast area.
Substantial environmental benefits will be lost if gas is not extended to the rest of the Province. Consumers will not have an equal choice of energy sources, and the much-vaunted liberalisation of energy policies will not have provided the benefits enjoyed by consumers in the Greater Belfast area and much of the European Union.
The Government have put the environment at the heart of their policies, and the NorthernIreland Housing Executive has designated gas as its preferred fuel for the future. How can the NorthernIreland Housing Executive deliver on that policy agenda when the north-west, with 24% of NorthernIreland’s housing stock, will not have gas available?
The Assembly should note that in those needy areas, and for those people of the north, the north-west and the north-east, the gas project will create about 2,000job years of employment and save the consumer more than £10million per year by the year 2000. That startling figure is a guaranteed figure and not some projected figure. It is the figure that CoopersandLybrand and PriceWaterhouse have put forward in their in-depth study on targeting social need. In the report the consultants said
"The failure to extend the gas pipeline to the north and north-west of this Province would, we believe, be difficult to defend in terms of the new targeting social need policy."
The Government have a responsibility to get on with ensuring that there is a level playing field for the providers of natural gas, not only in the GreaterBelfast area — which I am glad to see — but across the Province. The experts back this proposal for natural gas, as do the politicians, so far as we can see. I hope that the voice of the Assembly will be added to the call for the provision of natural gas across NorthernIreland. Such a development would ensure that everyone in the Province would have an equal share in the benefits that natural gas would bring.

Mr Gerry McHugh: A Cheann Comhairle, I support the motion, and I support Group 22 in its campaign to extend the gas pipeline to areas outside of Belfast, especially to areas west of the Bann, part of which I represent. There are great benefits, especially to rural areas, from a cheaper fuel source. The availability of gas is an issue of equality. We have a right to have the same access to cheaper fuel as people in any other part of the Six Counties, to produce and have energy that can be used to help bring economic benefit to our areas.
There are energy savings to be made. The economic progress of our area depends on access to cheaper fuel in the future. There are also environmental benefits for the future to be considered.
Reducing peripherality is another aspect of our constant fight. We who live west of the Bann have a battle on our hands every week, year in and year out, to defend our areas against job losses and against the continued pressure for jobs to be moved to Belfast and other built-up areas. Quite a lot of this seems to have to do with mindsets.
Mr McCartney spoke of people wallowing in the past. In the last nine years there has been inward investment of only some several million pounds to Fermanagh/South Tyrone out of a total inward investment amount of £379million.
Recently £87million was allocated for road structures, restructuring and infrastructure, and Fermanagh got absolutely nothing. I am not speaking of the past. That was our future just a few years ago, and that is now the present. I am stating facts, just as other people state facts about those areas. We are not talking about the past or about hundreds of years ago. We are talking about the present, and we want it to change.
It is important that there is change because that concerns equality, and we want equality on the economic side. There is also the business of political clout. Most Members of the Assembly come from east of the Bann. We shall therefore have an uphill battle on all these fronts. The mindset of the Government and their officials has been to keep inward investment from places like Fermanagh. The facts are staring us in the face; you have only to look. This is not something that we are making up.
Domestic consumers should have a choice of cheaper fuel if it is available. We have to pay the highest price for virtually everything in places like Fermanagh/South Tyrone, where there is a monopoly at work.
There are positive aspects too to increased employment. We hope that we can get new and small industries into our areas and support them. We hope that we can have cheaper fuel to help to attract them.
There is a cross-border dimension as well. There is a whole region on the far side of Fermanagh —Donegal, Leitrim and other areas could be considered when the viability of a gas pipeline is under discussion.
At the margin there is the recent agriculture crisis and we will have the fallout from that over the next 10years. The future needs of that industry will have to be considered, given that young people will not continue to work in it. There is a need for farm employment to help with future needs, and cheaper fuel could well be the kick-start that is needed for agriculture.
We have to look at the document which could shape our future. Its aims and objectives have been rural regeneration, economic development and a living and working countryside. That is what we want to move towards and we look at the facts and figures and at the aims and objectives of some of these reports, and we wonder how genuine they are. We need to see all of this happening in our areas. We need to know that we are going to be treated differently in the future.
Equality is a political matter, but we also need equality between east and west. Outside Dublin there is the same type of situation: the deprivation in rural areas.
Everything is pushed towards the built-up areas because of the greater population and political clout. I should like to see change, and thus welcome the opportunity to support the aims of the motion, which will benefit rural areas. The issue needs to be re-examined by the Minister, in particular in relation to rural needs and equality.

Dr Esmond Birnie: I welcome the motion. The extension of gas pipelines beyond the Greater Belfast area depends to a large degree on an increase in the capacity of the trans-Irish Sea pipeline from Scotland to Belfast. In the absence of such doubling up, it is doubtful that either a north-west routing of an additional pipeline or a supplementary pipeline through the Lagan Valley will be achieved.
Maximum interconnection between NorthernIreland and the national and European gas networks is of great value.
First, there is security of energy supply because being part of a larger network results in cost economies and lower prices.
Secondly, through the existing interconnection of gas systems and their possible extension, there is greater competition between energy types, thus putting pressure on electricity prices. I see no conflict between proposals for additional gas pipelines and the development of the electricity interconnector. Both will result in greater competition and liberalisation of energy markets.
Thirdly, there is competitive advantage to energy users, especially industry. Electricity prices here are one quarter higher than in GreatBritain, though for most manufacturers energy costs amount to only 3% or 4% of company turnover, so the cost benefit which might be achieved through cheaper energy sources should be not exaggerated. However, there will be some benefit.
Fourthly, there is the environmental issue — natural gas is relatively clean energy. Carbon emissions, particularly of carbon dioxide, are lower than those from coal or oil. That is important because NorthernIreland, as part of the UnitedKingdom, must meet CO2 reduction limits by 2010.
Mr Doherty recommended a cost-benefit analysis of pipelines, taking wider social benefits into account. Such benefits would be above the bottom lines of companies such as PowerGen, which might be involved in these projects. I agree with him.
However, Members must first consider the cost benefit of doubling up the Scotland-Belfast gas link, and look at the proposed north-west routing of a pipeline — the main subject of the debate — and at the possibility of a pipeline through the Lagan Valley. After all, that region has a population of the same magnitude as the north-west corridor. Both of those potential pipelines will require an element of public subsidy.
This debate has displayed how NorthernIreland, despite being a small region normally regarded as being economically depressed, has in it significant disparities of income and employment.
The explanations are complex, but, basically, this situation exists because new economic activity tends to be concentrated in areas where there is already substantial economic activity. This is unfortunate for those areas which are left "in the cold", but it is not, necessarily, a sinister development. Contrary to the arguments made by SinnFein Members this morning, academic studies of the subject provide little evidence to show that these disparities of income or employment were deliberately created by the Government, either in the pre-1972 Stormont era, or in the period of direct rule which followed.
There are, of course, various ways in which the Government could try to redress these disparities. However, I would caution Members against believing that large-scale, and potentially very expensive, public intervention in the energy industry would necessarily represent the most cost-effective way of achieving greater economic parity across all regions.
It is desirable that every home in NorthernIreland have access to natural gas, but we should not regard this as a fundamental human right. AdamSmith, the eighteenth-century Scottish economist, wrote, somewhat tongue-in-cheek — to borrow an earlier phrase — that it would be desirable to grow wine in the Scottish Highlands.
He went on to say, however, that it would be too costly to build the necessary greenhouses on the slopes of Ben Nevis. In the same way we need to be careful, subject to the full cost-benefit analysis, that we do not commit ourselves to astronomically expensive projects when there are other, less costly, ways of providing economic support to disadvantaged areas of the Province.
As regards the pipeline, given that public finances will, almost certainly, be limited, the Assembly may find itself faced with the difficult choice of whether to extend the pipeline along the north-west corridor, or along the Lagan Valley. Until such times as this kind of decision has to be made, I am happy to support the motion.

Dr Sean Farren: I welcome the opportunity to participate in this debate. The obvious consensus that has emerged is very significant. In itself, this underlines the urgent need for agreement on the outstanding political issues so that we can concentrate on the kind of issues we are discussing today and make the kind of decisions which are commensurate with our responsibility to ensure the good management of public finances and the provision of the best possible infrastructure for the energy supply industry and for all other related industries. I note and support many of the points that were made by the last Member who spoke.
With regard to the matter of energy supply in NorthernIreland, many commentators have pointed out that the market is too small to allow for significant economies of scale.
There is a need, therefore, to look at wider contexts in which to make such economies of scale possible and to take advantage of the different energy sources available. Such contexts include Scotland, the South and, indeed, the European mainland.
Given the current expectations associated with new North/South opportunities, many people anticipate enhanced co-operation in the area of energy supply. With such large investments required — a point which has been stressed in several Members’ contributions — there is a clear imperative to take advantage of the obvious mutual benefit that could be derived from meeting the needs of a market from both parts of the island by co-ordinating the planning of an energy strategy.
A critical objective for NorthernIreland must be the achievement of the lowest possible electricity supply costs. The continuing high cost of electricity is a deterrent to investment and places NorthernIreland at a considerable disadvantage in comparison with the South. In the South, low energy costs, combined with other incentives, add to its advantages when investment decisions are being made.
Central to the consideration of future energy strategy should be the question of gas supply in both parts of the island. Indeed, now that we are moving towards the adoption of a strategy that will lay the basis for energy supply far into the next century — and this is being clearly anticipated by the economic strategy review underway in the Department of Economic Development — we must ensure that the most effective gas network, in terms of both security and value for money, is developed for the whole island.
It is therefore critical that planning for a gas supply be undertaken in the context of the needs of Ireland as a whole, but with respect to the northern half of the island in particular. In my view, a line drawn from Dublin to Galway and northwards would be the immediate context for the development of an appropriate gas-network strategy.
We know that in the South planning is well advanced for the next phase of the gas network. And with additional connections being planned into Scotland’s gas network, it is critical that a northern link be included to create an all-island network.
Recent discoveries of viable gas fields in the Corrib exploration area off the west coast of Ireland underline even more pertinently the need for such a provision. Extending a network beyond Belfast to service the north-west, as well as customers along the Belfast to Newry axis, should form part of such a strategy.
We must begin comprehensive negotiations with the appropriate authorities in the South because, in the absence of negotiations, plans could be advanced for additional links to Scotland without any consideration being given to the development of a North-South link.
As part of an overall development, I, like many of my SDLPcolleagues and other Assembly Members today, urge that an early decision be taken to build a new gas-generating plant at Coolkeeragh. A new gas-fired generating station there, which would be a significant customer for a north-west gas link, would not only ensure the continuation of generation there and the retention of the expertise involved, but also provide a new and important addition to the area’s industrial and commercial infrastructure.
The availability of a natural gas supply along the north-west corridor would make the whole area north-west of Belfast more attractive — towns such as Ballymena, Ballymoney, Coleraine and Limavady where the commercial and industrial sectors are already expressing considerable interest in the availability of gas.
In keeping with the general plans for regional development over the next two or three decades — plans revealed last week place emphasis on growth areas outside the eastern corridor — the needs of the north-west must receive special attention. If this focus is to be meaningful, the provision of energy supplies — particularly via a gas pipeline — deserves special consideration.
Many Members have referred to the economics of developing the gas supply, and we will face hard decisions when we address that issue.
The emergence of public and private partnerships is a notable feature of recent economic planning, particularly with respect to infrastructural initiatives. We have already had some examples of that approach here; the Scottish interconnector could not have been planned without guarantees of public financing.
In terms of the overall need for infrastructural development, as well as of economics, there is an imperative that the motion recognizes. We should call for the papers; we should have an early opportunity to examine the evidence in detail, after which we will probably recommend that this development proceed so that secure, efficient and cheaper forms of energy can be provided in the north-west and south-east.

Mr Sean Neeson: I welcome this debate. I remember the last time the natural gas issue was debated in an Assembly. I and my party were booed and heckled because we supported the extension of the Kinsale pipeline to NorthernIreland.
Let us have some reality here. Unless we move forward with the formation of the Executive, the Departments and the North-South bodies, this morning’s exercise will have been a waste of hot air.
I believe that in this Chamber there is a desire to move forward so that the Assembly can take the decisions that —

Mr Roger Hutchinson: This has nothing to do with the debate. If the Member has something constructive to say about the pipeline, let him say it. Let us not bring politics into this issue.

Mr Sean Neeson: What I am saying has everything to do with the debate. If the Assembly wants to move forward and take decisions on Belfast Harbour or on the natural gas pipeline, then it has to have real powers. Such decisions cannot be taken unless the power to do so is transferred. We must move forward with urgency and develop the Assembly’s structures.
I support the resolution. It will bring major benefits to the north-west, however, I greatly resent the Government’s decision to go ahead with the interconnector to Scotland while this issue remained unresolved. On Tuesday 17November I requested a meeting with MrIngram on this subject and on 18November he made his decision on the interconnector. I find that decision despicable.
A meeting is to be held with the Minister on 6 January. I have written to the other parties, and I hope that, on that occasion, all the parties in the Assembly can unite to try to persuade the Minister to look with some urgency at the development of the north-west pipeline.
This is a bread-and-butter issue, similar to the integrated schools issue. We went to that meeting together — almost united — and the Government responded very positively. Regrettably Ulidia School, which is in my constituency, did not benefit, but we live to fight another day. If we are to move forward, let us get real about powers for this Assembly.

Mr Arthur Doherty: I thank everyone who participated in this debate, and I am grateful for such widespread support, albeit one or two Members widened the debate considerably to deal with lignite and Belfast Port, both important in their own right, but a little outside the scope of today’s debate.

Mr Roger Hutchinson: Will the Member give way?

Mr Arthur Doherty: This is my maiden speech, and there is a tradition that one does not give way in a maiden speech. However, I will be unmaidenly tomorrow and will accept any advances that are made to me.
If anyone is still lukewarm about this issue, may I point out that it is of importance not just to some areas. It is vital to everyone in NorthernIreland, for a country divided against itself cannot prosper.
My initial contribution to the debate, of necessity, painted a fairly bleak picture of the present situation, and a bleak picture of the consequences of further Government inaction.
Perhaps the best way to respond to the many vital points raised today is to concentrate on the positive benefits that would come from the extension of gas provision, and to call for positive Government action in terms of carrying out a comprehensive socio-economic analysis, as well as positive action to ensure that funding is available for a project that will bring great benefit in many fields — the economy, the environment, energy policy and social need.
It is an excellent European Union structural fund project that will facilitate diversification of the local economies and improve industrial competitiveness. It would be a flagship project for this region, and would be in line with many Government and EC objectives. There is already a real and committed private sector interest in this project. Environmental benefits are many. The north and west would be able to contribute their share to the reduction of global warming and the promotion of a clean environment by a significant reduction of emissions of carbon dioxide, sulphur dioxide, black smoke and nitrogen oxide.
The net present value of the reduction in environmental damage costs would be about £20million over 25 years. In terms of energy policy, the extension of the gas pipeline would fit well with the Government’s stated objectives in this area, and would reduce costs to consumers by almost £10million per annum over 10 years.
Finally, there are no more compelling arguments in favour of the extension of natural gas than those relating to social need. I congratulate the Assembly for its appreciation of this matter and for its support. I beg leave to withdraw the motion.
Motion, by leave, withdrawn.
The sitting was suspended at 12.35 pm.
On resuming —

Hospital Service

Lord Alderdice: We will now move to item 4 on the Order Paper. Members will have received the Government paper entitled ‘Putting it Right’, a report on Northern Ireland’s hospital service. The Minister responsible for health and social services, MrJohnMcFall, has agreed to present to the Assembly the material outlined in it.
Proceedings will take the form of a take-note debate. The motion in my name does not imply approval or disapproval of the paper, but simply notes it. The Minister will speak to the paper, and a debate will follow under our Initial Standing Orders. At the end of the debate, the Minister may choose to respond.
Motion made:
That this Assembly takes note of the report ‘Putting it Right — The Case for Change in NorthernIreland’s Hospital Service’, as presented by MrJohnMcFallMP, Minister for Health and Social Services. — [The Initial Presiding Officer]

John McFall: Closing his RichardDimbleby lecture a fortnight ago, SenatorMitchell talked of his hope one day of coming to a NorthernIreland at peace. He said
"and, on a rainy afternoon, to visit Stormont to watch and listen to Members debating ordinary issues of life in a democratic society — issues such as education and health care."
I am delighted to be here to discuss such a crucial issue, the future development of the Hospital Service in NorthernIreland. Shaping the future of NorthernIreland’s Hospital Service is, I believe, one of the early political challenges facing the new Assembly, and I hope to explain why.
I know from my own experience in Scotland just how difficult it is to address the complex issues associated with the Hospital Service. It is not easy to achieve change. Yet change is vital if this great service is to weather the pressures that it now faces and to emerge as a first-class service that all of our people need and rightly demand.
The challenge facing the Assembly is to see beyond the pressures on individual hospitals and local services, and to grasp the strategic picture. It is for the Assembly to develop a coherent and stable Hospital Service for the NorthernIreland of the twenty-first century. To do so, Members must pioneer new and collaborative approaches to hospital provision — in essence, putting patients before facilities.
I well understand the fears of local communities when services are to be apparently "cut" or "downgraded". But I also well understand the need to develop the hospital service strategically if it is to deliver the standard of service that people will have the right to expect in the twenty-first century.
It was specifically to help the Assembly with this task that I produced ‘Putting it Right’. It is an important document setting out the most radical approach to Northern Ireland’s hospital provision in 40years — yes, 40years.
Too often our debate about hospitals centres on bricks and mortar rather than on delivering the best possible care for patients, and patients have a right to receive the right care in the right place at the right time and from the right person — that is what matters.
It is a sad fact that the quality of some of our services is simply not as good in NorthernIreland as it is in other parts of the UnitedKingdom, and we must address this urgently. We have to do better and ensure that our services are second to none. This means change — we cannot cling to the past.
Let me say clearly and unambiguously that this strategy is not about cutting expenditure; nor is it about closing hospitals. None will close, but all will change — and change for the better.
The Government have already signalled the importance that we attach to building a modern and effective Health Service. NorthernIreland’s Health Service has already received an additional £60million since the Government came into office and will continue to get its fair share of future investment.
Earlier today I gave details of the massive boost for health and social services in Northern Ireland arising from the comprehensive spending review (CSR). As part of our commitment to modernising the service, we have already spent substantial additional funds this year — about £53million. Over the next three years, an additional £732million will be available to spend on health and social care.
Detailed decisions on how the extra funds are to be spent will ultimately be for the Assembly, but for the 1999-2000 financial year it is planned that the following programmes will benefit.
Community care will receive an additional £25million; mental health and learning disability services will receive an additional £5 million on top of the £25million for community care; childcare services will receive an additional £7·5million to take forward the implementation of the Children Order and to make improvements in children’s homes; cancer services will receive an extra £7million and renal services an additional £1·5million to support the continued expansion of the service; the building and maintenance programme will also receive an extra £6 million for the capital programme and last, but by no means least, acute services will be provided with an additional £7·5million to reduce further the number of in-patients waiting for treatment and to contribute to the meeting of other pressures.
What needs to change in the Hospital Service? NorthernIreland’s Hospital Service is facing a crisis. What we have lacked is a clear vision of the way forward and a plan to address urgently a number of critical problems facing the service. Without prompt action there is a growing risk of service breakdown.
All patients should receive the same high-quality care regardless of where they live. That does not always happen at present, and some patients are being admitted to hospitals that are not adequately equipped to provide the support they need.
I have looked at the current services and have found a number of causes for concern. For example, because they work in small hospitals, some doctors are on call for 104 hours week after week. How can these doctors be expected to provide a quality service on that basis?
Some surgeons, without the best training, are performing major operations. How can this guarantee quality service? Services at busy major hospitals are being held back by lack of resources, while smaller units are tying up expert staff to undertake a handful of procedures each day. Does this make sense?
Small hospitals, struggling to meet rising standards, are heavily reliant on a diminishing pool of general surgeons. How can this benefit patients?
Small maternity units do not deliver enough babies to justify employing expert children’s doctors to deal with emergencies. How does this secure the safety of mother and baby?
More than half of Northern Ireland’s accident and emergency departments lack the expert staff and support necessary to treat serious injuries or illnesses. This can cost lives. The fact that the service has coped until now is a mark of the skill and dedication of staff at every level. But we cannot base future service provision on the continued selflessness of staff.
What needs to be done? I said earlier that patients have the right to receive the right treatment in the right place at the right time, delivered by the right person. To achieve this, hospitals have to be organised to make full use of the considerable skills and talents of professional health staff. Our goal must be to ensure that all patients, no matter where they live, receive an equally high level of quality health care.
In searching for the best answer, I looked at a number of possible ways forward.
First, keeping hospital services as they are. This approach would not guarantee a sustainable Hospital Service of modern standards. Hospitals which serve small populations do not treat enough patients or illnesses to allow their medical staff to acquire or maintain skills. Difficulties in training and recruiting staff mean that the current service cannot be maintained.
Secondly, expanding the services available at all existing hospitals. The problems facing the Hospital Service are not primarily about money. They are more about how hospitals are structured to pool expertise. Spreading scarce resources more thinly would result in equipment being underused in many hospitals and highly trained and motivated staff struggling to maintain their skills. In other words, spending more to buy less.
Thirdly, concentrating services. The British Medical Association and the medical Royal Colleges suggest that a population the size of NorthernIreland should have only three major hospitals. This could improve the quality of care for people with major illnesses but would raise serious issues about access to services for people living in rural areas.
None of the approaches I have outlined guarantees a first-class, accessible Hospital Service.
What we need is a new approach, with all of our hospitals working together in clinical networks to improve patient care. This will allow the hospitals to be mutually supportive and make the best use of staff and other resources.
Future services will be provided in local hospitals and will be strongly linked to area hospitals and directly supported by them. Major illnesses will be treated at area or regional hospitals where patients can be guaranteed expert care and treatment for the most serious conditions.
This will allow the relocation of some existing services, with the presumption that care will be provided close to patients’ homes where this is in their interest.
Local hospitals will be NorthernIreland’s hospitals of first resort. They will be strongly linked to area hospitals and develop an increasing number of services with them. More and more frequently, patients will go there for investigations, for outpatient clinics and for day treatments, including day surgery.
These hospitals will provide an important base for consultants, many of whom will divide their time between area and local services. They will have specialist diagnostic equipment and the staff necessary to provide a full range of outpatient clinics and day surgery. These operations will be provided locally unless there are good clinical reasons to do otherwise.
To deal with problems of access in the more remote parts of Northern Ireland, three local hospitals will provide a more general acute service to their local population. They will be an integral part of the area network and will be located at Coleraine, Daisy Hill in Newry and in the southern part of the Western Board area.
Patients with the most serious illnesses will be sent to their area hospital. This will provide a wide range of specialties. Area hospitals will be equipped to deliver high-quality specialist in-patient care and to offer a round-the-clock emergency operating service.
The regional Hospital Service will provide patients with access to highly skilled care and treatment, supported by the latest technology such as coronary bypass surgery and kidney transplantation. They will continue to provide patients in NorthernIreland with skilled care and treatment supported by the latest technology. They will be centres of excellence in their own specialties, and they will share knowledge and experience with other hospitals in Northern Ireland’s clinical network.
I appreciate the concern about the future of accident and emergency services. There are 16departments in NorthernIreland, the majority of which do not meet current standards. We need to develop a strong local service to deal with the majority of minor or straightforward treatments, and some state-of-the-art units to cover the major injuries and life-threatening traumas.
Most patients will be treated in new local accident units in each local hospital. These will be led by nurse practitioners, supported by specialist staff and by services that are based at the nearest area hospital. The specialist accident and emergency departments will be in area hospitals which will be staffed and supported to provide the very best of accident and emergency care and treatment. They will directly admit serious accident cases and people with major illnesses, and will be able to initiate immediate treatment.
In recognition of the problems of people living in rural isolation, the three local hospitals that provide a more general acute service will also provide a range of accident and emergency services which will be networked with the closest area accident and emergency department.
To make this approach work, we must have a first-rate ambulance service, supported by a highly trained ambulance staff. Ambulances must be able to pick up emergency cases quickly, provide instant treatment to stabilise seriously ill patients, have computer links to expert support, and be able to bring a patient from anywhere in NorthernIreland to the right hospital, quickly and safely. This service must be an integral part of any new arrangements.
To make the vision a reality, we need early action to build up the service and enhance the training of ambulance staff. A commitment is also needed to develop a future specialist transport service to transfer seriously ill or injured patients safely between hospitals. That will mean new investment in these vital services.
Our hospital service is too important to be allowed to drift towards crisis. That is why I am opening up the debate on the way forward, and I am offering to make myself available to discuss these matters. There is an urgent need for a new strategic approach to hospital services. Inevitably, the future of hospital services will be one of the first major issues falling to the Assembly. The paper has been prepared to assist the Assembly with that difficult task, and to ensure that the strategic issues underlying any decision are understood and appreciated.
While it will be for the Assembly to decide what must be done, the proposals offer a practical and realistic way forward. They will ensure that patients get the same high-quality care no matter where they live, and that they will be treated by doctors who are not working impossibly long hours, thereby guaranteeing better quality care.
Patients needing major operations can be confident that they will be undertaken by fully trained specialist surgeons working in expert teams with full clinical and technical support, and they can be assured that hospital resources are fully focused on delivering the best patient care rather than propping up declining services.
Mothers-to-be can be confident that the maternity unit they attend has expert staff and that they will be able to choose the type of delivery that they want in a safe environment. Seriously ill patients who attend accident and emergency departments will get the highest possible quality of expert care and treatment.
Local accident units will quickly and effectively treat patients with less serious conditions. Patients needing emergency treatment will receive high-quality care from a rapid response ambulance service, with expert ambulance staff in direct communication with specialist teams in an accident and emergency hospital department.
While the Assembly must take the major decisions on the future of hospital services, there is an urgent need to develop the ambulance service. A modern and highly proficient ambulance service is the key to unlocking the way forward. With that in mind, I recently commissioned a major review of the service which will point the way forward and make the best use of existing resources. More needs to be done. To help build the service that we need, I am prepared to commit £15million over the next three years.
The overall challenge for the Assembly will be to agree a strategy that will address current pressures and enable our hospitals to deliver the first-class service which patients have the right to expect well into the next century.
In the meantime I will take whatever decisions are necessary to preserve the safety and effectiveness of our hospitals. I would like to think the Assembly will be able to relieve me of the task of setting its future direction. I am convinced that change is needed, and needed soon, if we are to deliver a modern and effective first-class hospital service which can meet the present and future needs of the people of NorthernIreland.
Fortyyears ago, at the time of the last major hospital review in NorthernIreland, the idea of man setting foot on the moon was sheer fantasy, but since then the world has unimaginably moved on. However, our hospitals have barely changed during that time.
It is time to plan for the next 40years so that those who serve the Health Service can work together as part of an extended team, and can be proud of their professionalism. They must be practising in an organisation that can exploit their skills, thereby serving the interests of patients throughout NorthernIreland. We need a service which does not cling to the past but looks to the future with confidence and "puts it right" for the twenty-first century.

Mr Sam Foster: I wish to welcome the Minister to the Assembly. He has kept his promise to meet us. We also welcome the announcement about extra finance.
This is a challenging time for health and personal social services in NorthernIreland, and we are aware of the big issues confronting us. Like the Minister, I am impressed by the skills, commitment and professionalism of the many capable people in the Health Service.
The paper ‘Putting it Right’ projects the future direction for hospital services in NorthernIreland. It points the way and we make the decisions. The Minister used a double-edged sword when he said "I have not interfered with your democratic right, neither will I allow myself to be your scapegoat."
Perhaps the paper should be called ‘Getting it Right’, but how do we go about that? The Minister’s presentation was concise, and I commend him on his honesty and frankness. He spoke about what needs to be done and said that hospital services were facing a critical time. He said there was a grave risk that services would break down, and mentioned the need to ensure reasonable access to acute services for people in the more remote parts of NorthernIreland. He said that a small number of local hospitals would provide a more general acute service for local populations.
People in rural areas fear for the future of their local hospitals. They feel under threat, and will fight tooth and nail to ensure that there is a hospital in their area. The threat to local hospitals makes people frightened and angry, and they also feel exposed and at risk.
In recent months I spoke to some health-care professionals, and I am aware of their concerns and of the requirements of the Royal Colleges. They are at the coalface, and the community needs the good quality service that they provide.
As I have said, people in rural areas are fearful. My constituency in Fermanagh equates to other rural areas, including south Tyrone and Dungannon. South-west Fermanagh is neglected in many aspects of public provision.
In the golden six scenario, Fermanagh and also west of the Bann are not catered for. Altnagelvin Hospital is in the Western Board area, but it is accessible to people in the south-western part of the board’s area only at the cost of travelling many miles. The Sperrin and Lakeland Trust covers a largely rural area in the local government area of Fermanagh, Omagh and the southern part of Strabane. The estimated population in 1995 was 114,000. The low population density creates some special problems in relation to the provision of accessible services. Another difficulty is that LoughErne divides the County of Fermanagh.
I refer to the 1994 "Social Deprivation" document of the Western Health and Social Services Board. The board looked at the work showing the strong relationship between health and deprivation, which replicated the work of Townsend. Fourkey measures of material deprivation were identified: unemployment, car ownership, home ownership and overcrowding. On that index, the three district council areas of Fermanagh, Omagh and Strabane are ranked 15th, 19th and 26th out of the 26district council areas.
Accessibility to services is a major factor that determines how needs can best be met. If people do not find the service accessible, it is a poor quality service. The road network from Enniskillen to Altnagelvin has slow journey times, and that unique situation needs to be taken into account. Concerns about the poor roads infrastructure and the importance of periods such as the golden hour are vital.
Four options for the future hospital provision in Omagh and Enniskillen were referred to in the review. These were: closure of both hospitals; no change; closure of both hospitals and a new building; one service on two sites. The last is the recommendation currently before the Western Health Board.
The Minister referred to the Accident and Emergency Service. Here is one of the most emotive topics when considering the pattern of acute services. This is a core service, and intense pressures would be created if one of the departments were to be wiped out. There is a sizeable demand from tourists at the Erne Hospital, amounting to over 25% of the summer workload.
The advantages of having two sites and one service are that they will maintain local access; they will improve the potential for some specialisation between and within the two hospitals; they will improve the management of clinical volume and workload across the two hospitals, and there will be the potential for economies of scale; and, as the Minister has said, they will be mutually supportive.
In 1996-97 the Erne Hospital admitted almost 11,000patients, with an average of 168beds occupied per day; accident and emergency attendances totalled nearly 17,000, and over 34,000outpatient attendances were also recorded. A hospital of this type is vital to the needs of the dispersed local community.
Vital economic issues also need to be considered. In 1996-97 Health and Social Services generated approximately £57million in revenue for the Fermanagh economy; the Sperrin and Lakeland Trust employs 1,764people in county Fermanagh; wages and salaries total £26·5million, representing 73% of all the income for that sector; and employees of the health and social services contribute £36million to Fermanagh’s purchasing power. Such a contribution is important for any rural area, and if it were to be taken away and not replaced, there would be great deprivation.
In summary, the Minister’s document is very general. On what basis are assumptions made to back up the proposed model? The joint council-Sperrin Lakeland Trust approach — a single hospital on two sites — appears to have been discounted — without any serious consideration having been given to it. The Western Health and Social Services Board’s review has been rendered useless.
The proposals are another example of applying an urban solution to a rural problem. No account has been taken of the physical infrastructure, as is evident from ‘Putting It Right’. The ‘Shaping Our Future’ strategy also lacks any reference to health issues.
Enniskillen and Omagh are two of only seven urban hubs identified in the ‘Shaping Our Future’ strategy. Emphasis should be placed on this proposal to ensure that provision is made to take account of this growth of 3,200 households.
The impact on the local economy must be considered fully in any analysis.
Tourism adds to the population that has to be served in that part of the Province.
The cross-border issue must also be considered, though this can and will work both ways.
The continuous erosion of services in rural areas may be exacerbated by this model, in which the local hospital becomes a "super health centre", causing rural GPs to relocate to larger towns in order to provide their service.
An upgraded and vital Ambulance Service needs an appropriate and good road network. Indeed, the Northern Ireland Forum for Political Dialogue presented a very good report on the Ambulance Service. We said that it has been the Cinderella service, but we hoped that that would change.
We need new and innovative thinking on the delivery of services by administrators and especially the medical profession.
Overall, the document appears to have been rushed. There is nothing about consultation or grounded evidence, and it makes many assumptions. Indeed, many specialisations "above and around the head" are not even considered — for example, ear, nose and throat treatment. I am convinced that we need to give services to the patients; not take them away. There is an ethical and moral issue to consider.

Dr Joe Hendron: I welcome the Minister, and I would like to thank him for the briefing he gave to the party spokespersons on health, prior to the launch of ‘Putting It Right’ on 30 November. The document sets out the difficulties facing the Hospital Service — particularly in the smaller hospitals — spells out the realities and emphasises the urgency of the situation.
This document is neither a Green Paper for discussion, nor a White Paper for legislation; the Minister is — quite rightly — leaving all the important decisions for his successor in the Assembly.
In the analysis, however, the Minister spells out the stark realities. In some areas patients are being admitted to hospitals that are not adequately equipped to provide the full range of tests and support they need. I agree with the Minister that continuing inaction could cost lives.
The situation is very serious, and professionals working at the delivery end of the Health Service have warned that an imminent crisis is facing some of the smaller hospitals. Every Member knows in his or her heart that urgent decisions have to be made. That is why I make no apology for stating a powerful political point. Only when the shadow Executive is formed and power is transferred to the Assembly and Executive will Members be able to face up to their responsibilities in respect of health issues.
There are many good and valid reasons for setting up the shadow Executive now. Indeed, it could have been set up last July. But, even at this late stage, Members must not shirk their duties. Health must be at the top of the Assembly’s agenda, and I call on the First Minister (Designate) and Deputy First Minister (Designate) to set up the shadow Executive forthwith.
With great advances in medical technology, the 17 acute hospitals in NorthernIreland cannot be expected to have a full range of specialist surgical, medical, paediatric and other services. The Royal Colleges are concerned about staff being adequately trained, and the Royal College of Surgeons has laid down specific criteria for an efficient, high-quality, surgical service. These include an accident and emergency department led by an accident and emergency specialist, round-the-clock availability of high technology equipment with CT scanners, emergency operating theatres and intensive care facilities. Only the Royal Victoria Hospital, the UlsterHospital and Altnagelvin Hospital comply with those requirements.
An accident and emergency department which does not have a consultant in accident and emergency medicine and which is without access to the full range of support services is not equipped to treat the most seriously ill patients.
It is essential that trainee doctors learn about the conditions and illnesses they will be dealing with. Hands-on experience is both necessary and mandatory, but, unfortunately, some smaller hospitals are not always able to provide the work experience necessary for trainees to develop that expertise and secure training recognition.
Quality of treatment and equality of success in respect of that treatment are essential for all the people. A proper balance must be struck between providing local services and treating complex and life-threatening conditions in major hospitals.
We are told that the focus of health care will remain in the community and that GPs and primary-care teams will be expected to develop and expand the range of services they provide. There is to be more scope for GPs to look after their own patients in local hospitals, providing patients with continuity of care. Nine out of ten patients are already treated in the community.
The Minister emphasises the development of nurse practitioners who can take lead roles in such areas as minor injuries and neonatal care. His vision sets out a new approach in which hospitals and primary-care teams work together. Most people have their needs met in the community or in the local hospital with relatively few requiring area or regional services.
A modernised Ambulance Service with skilled staff, who are to be known as first responders, will use motorbikes — that is certainly an interesting idea — cars, or whatever is necessary to achieve an effective response. The local hospital is to be the cornerstone of the future Hospital Service — although I accept that every hospital cannot offer a full accident and emergency service, and the idea of a local accident unit does make sense.
The Minister’s Paper is hard to fault so far as principles are concerned, and, in most respects, it follows successful regional strategies, although it does contain some new points.
Major changes are proposed, but at what point should they be tested by way of public consultation? Will they be subject to policy appraisal and fair treatment analysis? Departments are required to take fair treatment aspects fully into account when developing new policies or reviewing existing ones. Was this done? If so, what was the outcome?
New features include great emphasis on additional services to be provided by GPs, some vague aspirations about networking, a significant dependence on nurse practitioners, the promotion of the three hospitals — Daisy Hill, Coleraine and either Tyrone County or Erne — and the demotion of LaganValley and the Mater to local-hospital status.
Has the Minister considered the workload that would arise from extending the services of the primary care team? GPs, nurses and social workers already have heavy loads. Should pseudo-hospital functions be added to already busy lives? The notion of networking is scarcely freshly minted, but what will it mean in reality? What new structures would allow practical additions to existing relationships between professionals? How many nurse practitioners are in the service, and how many will be needed to do what is proposed? Are training arrangements in hand, and how many people are in training?
Most people will welcome the formal recognition of the three hospitals in addition to the golden six. Community services will escalate. It is not a solution to problems in the hospital service to dump them on other hardworking people who are under-resourced.
The major impediment to the Minister’s vision is undoubtedly the potential capital cost. For example, in winter, medical emergencies in Belfast can be a nightmare. Beds are like gold dust, and patients queue in accident and emergency departments if not in the corridors of the Royal and the City Hospital.
There is simply no prospect of the two big hospitals functioning in winter if they have to add the in-patients of Lagan Valley and the Mater to their existing load — unless of course there is significant additional capital expenditure.
The proposal to demote the Mater Hospital does not make sense when it seems that the Government have already decided to invest £7million in a new ward unit. Has this decision been rescinded?
SDLP colleagues and I have had discussions with Dominic Pinto from the Omagh Hospital, KeithMarshall of the Erne, BasilMcNamee from Dungannon and PatrickPiper of the Mid-Ulster Hospital. From our discussions it is clear that a major area hospital is essential in the south-west, the territory which stretches from Magherafelt to the distant ends of Fermanagh. The precise location of that hospital will be discussed in the future.
The great killers in Ireland, North and South, are cancer and heart disease. Cancer services for NorthernIreland are to be concentrated in the City Hospital. Senior cancer surgeon MrRoySpence and Professor of Oncology PatrickJohnston have joined forces with colleagues in Dublin on the research and development of cancer services for the island as a whole.
Major, expensive technologies have been developed. PET, or positron emission tomography, is a new procedure which allows a physician to examine images of the heart, veins and other organs. Unlike x-rays and CT and MRI scans, which show body structure or anatomy, PET images show the chemical functioning of an organ or tissue. PET technology can have a huge impact on the diagnosis of cancer, brain tumours, heart disease and other disorders.
I strongly support the acquisition of this important technology for use on both sides of the border. It would be too expensive for any one area to purchase, but its use would save many lives. The United States and some European countries have been using PET for some years.
It is for the Assembly to ensure that everyone in Northern Ireland has equal access to a first-class health service. Important decisions must be made sooner rather than later.

Mr Oliver Gibson: I congratulate the Minister on his presentation and on being the first Minister in 40 years to examine regional hospital provision. Forty years ago in an attempt to cure health problems, a series of hospitals were created, but many have closed. I am rather wary about the Government putting matters right, because it seems that the hastily prepared solution omits rather large rafts of provision that are necessary to make an acute service work.
Rather than a long-winded speech, I pose some questions for the Minister. First, does the Minister think that the golden six hospitals are in the right positions?
Is there not a case for a seventh golden hospital? The Minister has heard of the endeavours mentioned by my colleague MrFoster from Enniskillen, and of the consultations about Omagh. Hospital provision in Fermanagh and Tyrone should be looked at. Tyrone is the larger rural county, with its centre of population in Omagh. Castlederg and Strabane hospitals have been closed, and to ensure equality of provision and availability in Dungannon, Cookstown, Kesh, Enniskillen, the Clogher Valley and Lisnaskea, there should be a golden hospital in the south-west of the Province. There is a reasonable case for the creation of a seventh or for the relocation of the sixth golden hospital.
In considering ‘Putting It Right’, we should bear in mind that the vast majority of the population does not require acute hospital treatment. Most people go to GPs and treatment rooms. To make acute provision work effectively, account should be taken of the raft of care that should be provided by primary care centres of excellence. Care provision in the south-west should be supported by such centres of excellence and, therefore, the Erne, Omagh and Dungannon hospitals should be retained and improved to guarantee employment and excellence of service.
Some areas of existing provision have given cause for concern in recent years. I think in particular of the hype surrounding community care. We were told how good it would be. Expectations were raised but the provisions were not adequate. Could there be a lessening of the hype and greater clinical objectivity? At times the Assembly is so elevated that even an archangel could not deliver its expectations. We need to be realistic in our deliberations.
Some people have had to travel from the west of the Province to London and to private hospitals in Scotland, as provision there is cheaper and more accessible. Patients and their partners fly out for surgery and a quality of treatment that is not available here, yet we are told that Northern Ireland provides the best service.
A simple hip replacement costs £8,000 in the Royal, £6,000 in Altnagelvin and less than £3,000 in Eglinton private clinic, while elsewhere it costs under £2,000. There is something wrong with the system, and Members welcome the fact that this document defies the boundaries of the boards.
Finally, I wish to make a special appeal for a 49-year-old who cannot speak and is severely mentally and physically handicapped. For 34years this person has been in Muckamore Abbey and is now being threatened with removal from 24-hour excellent care to community care.
My Christmas appeal to the Minister is to ask him to consider the case of Pauline, who is 49years old, and her family, who are not able to care properly for her because they themselves are elderly. He has it in his power to give them a Christmas present which they would very much appreciate.

Mr Francie Molloy: A Chathaoirligh, I would like to welcome the Minister and the discussion document ‘Putting It Right’. It is important that we have a document which sets out a vision for the future of health care. This is the first opportunity that we have had to debate this issue. In the past, we have been told about services which are to be taken away, but not given any details of what services are to remain.
I would like to pay tribute to the staff in all the hospitals in the North. These people — doctors, nurses, ancillary staff, cleaning staff — have provided an important service to all of us in very difficult circumstances. They are a credit to their professions and a credit to the community.
We all have to recognise the need for change, although, obviously, no one wants these changes to take place in his or her area. We must move forward. Nonetheless, there are few areas of public policy which are more emotive than the provision of a health service. The document states that the changes are not simply cost-cutting or closures, and I hope that the Minister will be able to reassure us today that the purpose of these changes is to ensure the best possible service for all of the people, wherever they live and whatever service they require.
The area which I represent, Mid Ulster, has suffered a double blow. West of the Bann, over the years, we have been deprived of jobs, investment in infrastructure, and, now, we are to lose two acute hospitals — the Mid-Ulster and South Tyrone hospitals. The perception is that these two hospitals have been reduced to the status of local hospitals, and we need to reassure those communities that these hospitals will continue to provide a proper service. The South Tyrone hospital is situated in the best position to provide a service to Mid Ulster as well as south Tyrone and would be well situated to provide a maternity service for the area, whether in the form of a designated maternity unit or midwifery services.
I welcome the fact that the document sets out the services which will be available at the hospitals and does not simply state which services will be removed. However, I do not feel that the document promises sufficient resources to sustain these hospitals in the future. We need to be sure about the extent of provision for outpatients, day surgery and other services to the community. We should bring together everyone involved in the provision of health care in each area to ensure that the proper resources are available.
I see much common sense in the document and agree that some changes are necessary. I urge all Members to discuss these proposals together, to ensure that we have a proper health service.
We could all demand that our locality be left with all the facilities of an area hospital, but that would be unrealistic. The Assembly will soon have to make some hard choices. We will not be able to blame Ministers in future. It is therefore essential that we create the Executive that will bring about the structures for taking decisions here and implementing them.
Only the best is good enough for the people we represent, and we must aim to provide the best health-care service. I was alarmed to read that services in some hospitals are in danger of breaking down completely. That would be a disaster and demonstrates the urgent need for the Assembly to take decisions on health-care provision. We must provide a modern Health Service which is equipped with the most modern facilities, information and technical back-up in order to deliver care as close as possible to a patient’s home.
People will decide with their feet. They will go to where the best services are provided, as they have done in the past. And I am convinced that they will do so in the future when they require specialist treatment.
One area requiring examination is that of preventative medicine. Many operations are carried out on a day-surgery basis, and I am thankful that that has removed much of the disruption and trauma for the patients and their families.
Health care is also about the environment, housing and jobs. Good health does not come from hospitals or doctors’ surgeries. As the Ottawa Charter on health promotion states,
"Health is created where people live, love, work, learn and play."
The road to reconstruction requires an attack on want, disease, ignorance, squalor, idleness and prejudice.
In the past I have been critical of the way in which decisions have been made without consultation with the community. People have been very supportive of all their local hospitals, which they want to ensure are not run down or closed. There is considerable fear among people that they will be deprived of a local Health Service. They want a reassurance for the future. It is important that we involve all the community groups in the decision-making process, those who have fund-raised and supported action campaigns, because they can play a crucial role in managing future changes.
What is right for patients is what matters, and that will require change and sensible compromises between local provision and high quality standards of clinical care. Treatment should not cause unnecessary stress to patients or their families.
Finally, can the Minister report on what provision is being made across the North to ensure the highest standard of clinical performance? Can he reassure patients that some of the recent scandals across the water — in particular, the one in Bristol — will not be repeated here, and that the people will receive the best possible standards of health care?

Mr Seamus Close: I too welcome the Minister here today to present his vision for the future of the Health Service. I have read with interest the document ‘Putting it Right: The Case for Change in NorthernIreland’s Hospital Service’. No one can deny the rationale behind the need for regional hospitals, which will provide specialist services for everyone in Northern Ireland in areas such as neurosurgery, paediatric neurology, heart surgery and cancer. However, I have a difficulty with the split between the area hospitals and the local hospitals and with the proposals for their respective services.
I come from the borough of Lisburn, and I represent the constituency of LaganValley, so the Minister will not be surprised to hear me argue strongly for the continuation of the excellent services that that hospital has provided over the years.
The borough of Lisburn is the second-largest in NorthernIreland, with a population of some 110,000people, and it is one of the fastest growing areas in NorthernIreland. The reason for its rapid growth is simply the excellent range of services provided for the people who live there. One of those excellent services is the LaganValley Hospital. The people of Lisburn would take it extremely ill if there were significant proposals to degrade or remove any of the services which are currently provided by that hospital. I am concerned that in the ‘Putting it Right’ document, the threat of the axe seems to hang over, in particular, obstetrics and maternity services. How could Lagan Valley be
"the cornerstone of the new hospital service" —
the Minister’s own words — if the maternity department were removed? How would Lagan Valley be treating more people if over 1,000 expectant mothers were forced to use another hospital? How could that possibly be construed as a change for the better?
I do not think that anyone would consider maternity to be a serious illness. It is a natural progression in the reproduction of life. I accept that difficult births make up only one in 1,000 or fewer of the total. We would be throwing the baby out with the bathwater, so to speak, if we closed down maternity services because of so-called higher standards that have been established by some consultant. Surely LaganValley Hospital, with its superb buildings and its proximity to Belfast hospitals, can be supported on an outreach basis to maintain all of its services, including maternity.
Given the Government’s emphasis on the environment, and the large and growing population of Lisburn, would it not be more appropriate to maintain a comprehensive range of local services, rather than have this large number of people — over 1,000 per annum — travelling in and out of central Belfast? On obstetrics, one option which I suggest for consideration is a consultant-supported, midwifery-led service. A similar trend is apparent in Lagan Valley Hospital. Midwives would take professional responsibility, but consultants would be based at Lagan Valley to provide the necessary advice and service.
Over the past 20 to 25 years, during which I have been involved in local government and in politics, my colleagues in Lisburn and I fought against Tory efforts to shift the goalposts and run down the services in Lagan Valley Hospital. In future, a Minister from the Ulster Unionist Party, the SDLP, the Democratic Unionist Party or Sinn Fein might take these so-called difficult decisions. Having fought the Tories for a quarter of a century, I will fight any of those parties in order to retain the service to which the people of Lisburn have become accustomed.

Mr Norman Boyd: I welcome the Minister. The people of the Northern Board area are being presented with a fait accompli and, as a consequence, alternative patterns of service and service models have not been properly explored. It is now being proposed that Whiteabbey Hospital be downgraded from an acute hospital to a non-acute hospital with adverse implications for the people of Newtownabbey, Carrickfergus and Larne. The Northern Ireland Information Service’s press statement of 10December said
"We have had extensive and unprecedented consultations with Assembly Members, local politicians, councillors, et cetera."
While I appreciate that the Minister has held meetings with us, it is clear that the Northern Health Board and the Health Minister are pursuing their policy before the elected representatives of the Assembly, who live in our community, are able to assess the whole matter of health.
The people of three constituencies — North Belfast, East Antrim and South Antrim — have said, through their representatives, that they do not want their hospitals to be downgraded. Instead they want the coronary care units and accident and emergency services to be retained to deal with their highly populated areas. Like MrClose’s constituency, Newtownabbey is also growing in population. We have an international airport, a university and many factories. We want to see capital investment in Whiteabbey and other local hospitals, not down-grading.
I propose that any service changes should be underpinned by the following principles. All current services identified for future provision from the Whiteabbey site should continue to operate throughout any transitional period.
The Ambulance Service must have sufficient, appropriately equipped vehicles and trained staff to enable swift response and rapid transfer to consultant-led accident and emergency service. Issues related to public transport must be resolved prior to the relocation of any services. Any changes must have the full support of the local general practitioners, some of whom are very vociferous in the campaign to save Whiteabbey Hospital; and finally, the local community must continue to be consulted on any proposed changes.
Last Monday Roger Hutchinson, my Colleague from East Antrim, and I spent three hours in Muckamore Abbey Hospital. To see those staff working night and day, sometimes with only five or six members of staff to cope with over 30patients was probably one of the most moving experiences I have ever had — they do a tremendous job.
As my Colleague OliverGibson has also stated, sometimes patients who have been in hospital for up to 25years are going to be put back into the community. Their families, who are very loving and caring, are being asked to take on this task of helping to uproot these patients from the environment which they have been used to for a lifetime. The manager of MuckamoreAbbey Hospital said that the only way in which they could make ends meet was to close down two wards.
No more hospitals should have to close their wards to make ends meet. I ask the Minister to make arrangements to visit Muckamore Abbey. I endorse my Colleague OliverGibson’s comment that we should save Muckamore Abbey Hospital and allocate sufficient money to allow it to continue operating.
I will give Members an example that will show them why I feel strongly that the local hospital at Whiteabbey, and others, should not lose their acute status. Twice in five years my mother has, sadly, had a heart attack. On the first occasion she was taken into Whiteabbey, stabilised overnight and transferred to the Royal Victoria Hospital. The second time was in February this year. The GP at Whiteabbey Health Centre arranged for her to be admitted to Whiteabbey Hospital on the Friday for tests. Unexpectedly on the Monday night, she suffered a massive heart attack — and I am thankful — Whiteabbey Hospital was able to save her life. The next day she was sent to the Royal Victoria Hospital for a life-saving operation.
The surgeons in the Royal said that but for Whiteabbey Hospital’s coronary care facility she would have died. She is enjoying as good a lifestyle now as she has had for many years. I challenge anybody to tell me that the case for closing the coronary care unit of Whiteabbey Hospital has been made.
Finally, I have no objection to, in fact I would welcome, a regional cancer centre for NorthernIreland but, as someone who has worked in a financial environment for 18years, I know that "centre of excellence" can sometimes be a fancy term for cost-cutting. I hope and trust that this matter is given full consideration before any decision is reached, and I hope that no decision is made by the Minister before locally elected representatives become responsible for such decisions.

Prof Monica McWilliams: I would like to welcome the Minister to the Assembly. Members have said "Yes, we are going to have to do something about the hospitals, as long as it is not our hospital. Yes, we are going to have to do something about the Health Service, as long as the Minister gives more money to my constituency." These are political and strategic decisions that cannot be put on the long finger and which Members will have to face.
The reorganisation of the Health Service is going to be one of the most difficult decisions that Assembly Members will have to make. The money is decreasing, not increasing, and certainly not keeping pace with the expenditure that is required for patients and for those in the community.
I once heard the expression "The operation was a success; it is too bad the patient died." One of my concerns about this document is that it is very much led by the Royal College. It is right that we train our doctors in specialist functions and that we have the best clinical effectiveness available. However, hospitals are also about the care of very sick people, not just the specialist treatment of a few. I have concerns that, if the Royal College were to lead the consultation process, all other voices that are so important to the discussion would come much further down on the list of the people to whom you have to listen. The Royal College is a very powerful body.
I am concerned too that we are talking over and over again about acute health services and care. We know that, with better prevention, we might not be having this debate. In this respect, NorthernIreland lags sadly behind the rest of the United Kingdom. Only around 2% of our budget goes on health prevention. We must take this area of health much more seriously.
This brings me to a very important point about community-based services. We have heard from Oliver Gibson, from a Member of the United Kingdom Unionist Party, from DrHendron and from others about the importance of community-based services. Figures from the comprehensive spending review were placed in Members pigeon-holes at lunchtime. Was that to remind us of the amount of money? We had not forgotten.
What is very important is that so little of the money is going to community care. We desperately need respite care and continuity care, particularly for the elderly who are being decanted at far too fast a rate out of geriatric units because there are no beds. Nursing homes are closing down because they are not meeting the health and safety regulations. Where are these elderly people going to be cared for?
Clearly the Minister has got to make a decision now on how the cake gets carved up. It seems that the budget has not reached the right places. Attention has been too much focussed upon the provision of acute hospital services. This is an argument which we must get right in order that the people of NorthernIreland have ownership of the decision on where these hospitals are to be located. I share MrFoster’s concern about the west of the Bann. It is right that the area’s representatives should raise the issue of the rural community’s reaction to this debate. I offer them my support.
It would be remiss of me, as a representative of the Women’sCoalition, if I did not say that most of the job losses will be women’s. Those who do the catering, cleaning and nursing — including the auxiliary staff — are predominately women.
How are we going to manage the transfer of jobs? Are we, under the Labour Administration, going to face increasing unemployment in the one area of the public sector where the lot of both Catholics and women improved in terms of the number of jobs available? Angels fearing to tread will become angels failing to tread. Again the argument lies around nursing and the remuneration of nursing, which is appalling given the enormous risks that nursing staff take day and daily.
We need to have a much clearer discussion about the Ambulance Service. It is painful for me to recall having seen an example of this at first hand. Two years ago, on a winter night in a rural area on a very lonely country road, my sister had the most appalling road traffic accident. The driver of the other car was killed instantly. My sister survived because a rural ambulance managed to get there.
She was taken to the hospital in Coleraine where a surgeon carried out the almost impossible task of putting her on a life-support system — she had punctured both lungs, which is a life-threatening condition. However, the most important outcome of all of that — I learnt much in those two days around the Health Service — was that she had to be transferred to the Royal Victoria Hospital where she got specialist attention in orthopaedic care.
NorthernIreland has moved very far in the last few years in not just bringing the solution to the problem, but in looking at the continuum of what is then needed to bring the problem to the solution. That night the problem was brought to the local hospital and later to the regional specialist hospital.
We do need to get it right. We must keep up with the rest of the world with our Ambulance Service and experienced paramedics. The coronary care units must be local. What happens if there is a crucial aneurysm that needs specialist attention? That is the kind of attention we need to pay to the Health Service: we need to take the problems to the solutions but also make sure that the solutions are available locally for emergencies that are life-threatening.
DrHendron rightly points us to solutions elsewhere — they do not have to be just here in NorthernIreland. I am aware of the dermatological telemedicine centre and of how skin disease can be diagnosed in the Republic of Ireland simply by screening through the services of a doctor in NorthernIreland. That is the kind of service that we should be looking at, NorthernIreland should not be working in isolation but building good communications and good technological services North and South.
Now I want to raise an important issue which concerns me, and that is who the Minister responsible will be. I would like it to be the Minister responsible for health and social services. Recently I was concerned at what I thought was a mistake when I read in the ‘Belfast Telegraph’ that "housing and social services" were to be a designated departmental body. I would be completely opposed to that. People have come from all round the world — health and social service experts — to study the one unique service that we have here, and that is the integration of health and social services.
Our problems are not always purely physical; they can also be social — it is the integration of that care that has made us one of the foremost bodies in the field. I would like us to continue down that road rather than enter some kind of separate, functional silo by putting health in one department and social services elsewhere. I welcome this report. The Minister’s hands have been tied where expenditure has been concerned, and I welcome the increases in the comprehensive spending review.
Could the Minister tell us how Northern Ireland is faring in relation to Scotland, England and Wales in terms of the increase in the budget? A great deal has been made of how the Minister won extra increases for the Health Service, but I remain concerned about new legislation such as the Children’s Order and the other problems that I have highlighted. Are we keeping up or are we now falling behind, like the other regions of the United Kingdom?
Let us not forget the enormous amount of informal community care that people in NorthernIreland have given voluntarily. This needs to be recognised in any debate. My final plea to the Minister is to take on board the problems we have raised here and ensure that the debate is as wide-ranging as possible and not led just by the articulate, elite few.

Mr Michael McGimpsey: I welcome the Minister here today, and I welcome and support the broad thrust of the document, in particular the recognition of the need for debate and for us to work out a vision for the Health Service in five years’, ten years’, 20years’ time, analysing where we are now and how we are going to go where we want to go. Strategic thinking is the key to this.
Health-care provision goes to the heart of politics, it goes to the heart of government, and it goes to the very heart of the ethos of the kingdom — namely, cradle-to-the-grave health care free for everybody. That is a basic right of all citizens of the kingdom.
There are some startling admissions that the hospital services are facing a critical time, that there is a risk that some may break down and that standards of care are not as good as they should be. It is for us in the Assembly, all things being equal, to debate and make the decisions on the way forward.
I recognise that the Minister’s inheritance is an unenviable one after 19years of a Conservative Government which took the view that health provision was about working out what funds were available and then ascribing them to the health service rather than working out what the need was and how that need should be addressed. I welcome the abolition of the internal market, fulfilling a promise made by the Labour Government.
There is a need to take an holistic approach Province-wide and also to pay attention to local needs. We cannot say that money does not matter. We have to manage local budgets — for example. Because of the lack of funding in the Eastern Health and Social Services Board area, in October, there were 149people on the waiting list for community-care packages and 100people in hospital taking up valuable hospital beds because community care was not available.
As a representative of South Belfast I must ask the Minister about the decision to close the Jubilee maternity unit in the City Hospital. I believe that that is a bad decision. It concerns us in the Assembly, and we will call on reports from experts.
A couple of years ago we got one such report, the McKenna Report, which after wide-ranging consultation decided that the Jubilee maternity unit should stay. This is a knock-on effect from the decision to centralise the cancer unit at the City Hospital. The sale of the Belvoir Hospital site will pay for this move. McKenna made a simple recommendation that Jubilee take over two floors of the tower block because the need in south Belfast demanded that the Jubilee stay. In that area there are 30,000 women of childbearing age. Currently the Jubilee deals with an average of 2,800births per annum. It has an intensive care unit for 350 to 400babies per annum.
A new report by Donaldson, without consultation and almost secretly, recommends the closure of this very valuable unit. That was a bad decision. It means that women in south Belfast will have to go to the Royal Victoria Hospital in west Belfast.
The Royal Victoria Hospital is presently working at its full capacity of 3,000births perannum. Occasionally the hospital has to send expectant mothers to the City Hospital. That is an example of a local decision which defies logic and rationality and it also flies in the face of economic sense. The Jubilee set-up in the City Hospital means that we do not have to spend money on new buildings. We can simply move it into two floors in the Tower block. The staff and equipment are there, and such a move seems sensible, reasonable and rational. It is unfortunate that decisions such as this are being made prior to the Assembly taking over responsibility.
The Minister spoke of putting it right and gave his vision of the future, but it should be left to the Assembly to make those decisions. The Minister should review his decision, or at least defer implementing it until the Assembly becomes responsible for these matters. If that is not done the RoyalVictoria Hospital, which is already working at full capacity, will be required to take on a further 2,800pregnancies. That is an impossible task, and mothers in south Belfast will be forced to go to the UlsterHospital or to LaganValley, should the concerns of MrClose be borne out.
This is an important document, but it is merely the first stage in what will be important business for the Assembly. Difficult decisions will have to be made by local politicians who will not be able to hide behind a NorthernIreland Office Minister.

Mr Eddie McGrady: I welcome the Minister to the Assembly and I welcome his opening remarks. I should like to put on record the thanks of our community for the additional finance for the Health Service to reduce waiting lists and ease problems in other areas. This document deals only with hospital services, and the Minister says that it represents his vision of the future of hospital services in NorthernIreland. The purpose of the document is to
"offer information, advice and assistance to the Assembly"
and presumably to the wider community.
I shall speak in the context of hospital services, and not on wider aspects of the Health Service, such as community care or ill-health prevention. The document states that it is important that care be delivered close to the patient’s home. The document also states that the provision of care is best when there is a sensible balance between accessibility of services and the provision of modern high-quality standards of clinical expertise. We all subscribe to those sentiments and most of us would agree that the Minister, the Department, the boards, the trusts and the practitioners want to provide the best possible health service. What is in dispute is how to achieve that. I do not agree with a great deal of the substance and conclusions of the document because they do not seem to match the vision and aspiration of the opening paragraphs.
In his opening remarks the Minister said that this was not about expenditure, and I accept that it was not about closing hospitals, but I question that, because when an engine is taken out of a motorcar and replaced by a foot pedal, have you still got a motorcar? That is the question. If the engine is taken out of an acute service hospital, is that still a meaningful hospital?
As anticipated for those listed in annex A, the asterisked exceptions, where services, such as general medicine, general surgery, obstetrics, paediatrics, gynaecology and accident and emergency, are taken out, what is left —a glorified GP polytech surgery? That will be the fate of many of the 12 mentioned in appendix A. There is no doubt about that, should the vision, stated in appendices A, B, and C, be put into practice.
Unfortunately, I draw my conclusions from the experience suffered, over the years, by my community at the Downe Hospital. In the Assembly, it is not appropriate to be parochial and simply deal with my home base, but what is happening there could be the blueprint for others. At the beginning of the document there is a paragraph that says
"some of our smaller hospitals are at risk of collapse."
One of the reasons for the risk is the uncertainty with which they have been visited time and again over the past two to three decades.
The confidence and morale of staff and patients have been undermined, and that is something we must put to bed once and for all. The providers of our health care are the Minister, the Department, the health boards, the trusts, the practitioners, specialist or general. Of course, the patients are also the customers. It is the practitioners and the patients who should make decisions.
Unfortunately, the decisions are often made only by the first three — the Department, the boards and the trusts. The experience of those working at the coalface and the recipients are often not taken into account, and that needs to be dealt with.
Two years ago the Department, the Minister, the board, the trust, the local practitioners and the community assessed the requirements for Downe Hospital and were advised to seek private finance. The Department approved the case but, lo and behold, private finance was no longer deemed to be suitable.
Was that judgement made on medical or financial grounds? Nothing had changed except the Department’s attitude. The board as the purchasers, the trust as the providers, the practitioners as the deliverers and the patients as the recipients were all still of the same mind. Only "little Johnny", the Department, "was out of step". One must question whether that decision was taken on medical service grounds or whether something else, such as finance — a dirty word — came in to play. That is the only thing that changed. Everyone else, except the Department, said that things were the same. We entered another series of reviews and the Minister’s predecessor, MrWorthington, decided to take a direction not a million miles away from the direction of this particular document.
The curious thing was that the six options presented by MrWorthington for consultation did not include any of the options that he adopted. Have we had consultation then? The jury may be de facto. But that took place without regard for the people concerned.
I commend the Minister for his endeavours and do not intend to diminish them in any way — for instance, he has reviewed the case, he has visited the hospital and he has listened to delegations.
When the then Minister, MrWorthington, made his decision he was challenged and reports were submitted and references were drawn to changing requirements in at least three different fields. In May to July last the joint working party of the Royal College of Surgeons, jointly with the British Medical Association, the Carter Review for the provision of hospital services in rural and urban areas of Scotland, and even the members of the Royal College of Obstetricians — which denied in a sense the basis upon which the previous decision was made — were put into the melting pot again, and no change took place.
I draw this parallel in detail because this is the sort of scenario that may be visited on other local hospitals. The previous Minister’s decision has been confirmed, and a special press release was issued four days ago in which the Minister asked the board to review hospital provision in the area in the light of ‘Putting it Right’ and to report their findings by March.
However, we do not know the parameters of the new business case. Is it the one which previously went to public consultation and to a private finance initiative inquiry and which was endorsed by all concerned, or is it a new one promoted by the then Minister, MrWorthington, or is it yet another new thing promoted by the Department and launched as this document? Those are the questions which we must address, as must the rural areas outside the conurbations of Belfast, Derry and Craigavon. That is why I make no apology for raising it.
MrWorthington made two positive points when making his decision. First, he said "We will build a new hospital in Down". Secondly, he said "No major changes to services provided in the Downe are planned until the new hospital opens." Yet the rundown of this hospital, through undermining and the creation of a crisis, is well under way. The community in rural Down and in other rural areas need to know exactly what "business case" is going to be applied.
I ask the Minister to listen to the people and to the practitioners. They are the deliverers, they are the receivers, and they are the people who should be satisfied primarily. There should be accessibility tempered with technical effectiveness.

Mr Jim Shannon: I welcome the Minister to the Assembly, and I thank him for his prompt responses to my letters.
My first question is about the Ambulance Service, specifically in the Ards Peninsula. The ‘Putting it Right’ document talks about making it happen. It says
"The development of a highly effective Ambulance Service must be integral to the new arrangements."
I want to illustrate the specific problems which the Ambulance Service has in my area. The roads of the Ards Peninsula are twisty, narrow, difficult to negotiate and the dangers are obvious.
The Ambulance Service response time, as stated in the citizen’s charter, is 18 minutes. On a number of occasions in the last few months, the response time from Portaferry has been 28 minutes, and in one instance in Kircubbin, it was 24 minutes. This was an ambulance coming from Newtownards to Kircubbin — a distance of 11miles. I am sure the Minister would agree that no matter how bad the roads are, 24minutes is not a satisfactory response time in which to deal with an emergency — in this case a child who had been taken ill.
The problem does not lie with the Ambulance Service or the crews; they are very efficient and have the necessary ability and experience. The problem is the fact that the Ambulance Service cannot cope with the poor-quality roads on the Ards Peninsula.
For many years, elected representatives have lobbied for an outstation in the Ards Peninsula. Can the Minister give an assurance that an outstation will be built at either Ballywalter or Kircubbin, thus providing constituents in the Ards Peninsula with an effective Ambulance Service which meets the standard laid down in the citizen’s charter?
My second point is in relation to the accident and emergency services, specifically those in the UlsterHospital at Dundonald. The Minister is aware of the many stories about its accident and emergency services, and Members have been trying to address these issues directly with the Department and with the hospital service.
We have heard stories about people who have had to spend up to 18 hours lying on a trolley and about people who have had a lengthy wait in a cubicle — indeed, one lady from Portavogie was forgotten about. How could anybody in a cubicle in the UlsterHospital be forgotten about? It is hard to believe, but it happened. All these things have happened because of the shortage of beds and lack of money.
Can the Minister tell Members how he intends to address the very serious problems that exist in relation to accident and emergency services in the UlsterHospital? These problems have nothing to do with the staff who are pushed and under a great deal of pressure. The service needs more staff, more beds and more money.
Would the Minister also like to comment on information that was given to me yesterday, namely that the accident and emergency service in the Ulster Hospital may be relocated, in the short term, to the Ards Hospital, because the UlsterHospital cannot cope with the demands?
Does the Minister agree that services should always follow demographic trends? The population of Strangford has increased by 16% in the last 10years. This demonstrates that people are moving away from the Greater Belfast area and into country areas. Consequently, greater demands are being placed on services there. I suggest to the Minister and his Department that services should be moved to where the people are.

Mr Martin McGuinness: I too would like to welcome JohnMcFall for this very important debate. It is obvious from contributions made by the representatives of all the political parties that they were articulating in a very heartfelt way their constituents’ concerns about the current state of the health service and what it might be in the future.
In relation to the document ‘Putting it Right’ and its vision of the future — and this is an important point for me — in recent times the Health Service in the North has been driven by bodies like the British Government, the Royal College of Surgeons, and the four health boards which have been established in the North.
There has been a totally lopsided approach to the issue of health, as is clear from the reaction of people in CountyTyrone regarding the south Tyrone Hospital; in south Derry regarding the Mid-Ulster Hospital; in south Down and in other parts of the North. The people who depend on hospital services have been absent from the debate.
The Government must take notice, just as we have had to take notice when we saw 20,000 to 30,000 people on the streets in south Down, in Dungannon and in other parts of the North. There is something seriously wrong when there is such a turnout of people objecting to the way hospital services are directed. People feel that this is an issue over which they have very little control.
It was clear to me, in the course of the Assembly elections, that, for the first time, people in the North of Ireland, certainly in the constituency that I canvassed, felt a sense of empowerment that at last hospital services were going to be in the hands of the local community.
I have listened to this debate and to the smart alecs in the media who say that it remains to be seen whether, on the transfer of power, we will be prepared to take the tough decisions. My party is not afraid of tough decisions, and there are representatives here from other parties who are also not afraid. We want to take those decisions against the background of a complete review of hospital services in the North, including the views of the Royal College of Surgeons and the health boards — or what remains of the boards after the Assembly Executive takes control. The views of the people who are directly affected by the hospital services — patients and potential patients — should also be sought.
People who voted in the Assembly elections voted for the fullest implementation of the Good Friday Agreement as a matter of urgency. We have come here today to raise matters with the Minister, and while we may have criticisms of the Government’s approach — and we certainly do — it is also fair to criticise the failure of the Assembly to provide, for example, a shadow Health Minister, and a shadow Committee on Health for the people who voted in the referendum and in the Assembly elections.
The Assembly has failed those people dismally. If we had in place a shadow Assembly Committee on Health and a shadow Minister of Health, we would be much more powerful in our debate with the British Government about the future of health services in the North. We would be much more relevant, instead of coming here today and listening to people with quite legitimate concerns about Whiteabbey Hospital, LaganValley Hospital, South Tyrone Hospital, the Mid-Ulster Hospital and hospital services in southDown. We have to get our act together, and we have to provide leadership.
There is much concern among people that, through the downgrading of hospitals such as Whiteabbey, SouthTyrone, Mid-Ulster and others, they are being softened up. We are being conditioned to accept, in the future, a hospital service which will revolve around the golden circle of six hospitals, the rest being reduced to the status of glorified health centres.
The document mentions no hospital closures, but I do not think it is being honest. Members are experienced politicians, and it appears to me that we are talking about hospital closures —ultimately, the closure of the South Tyrone Hospital and the Mid-Ulster Hospitals. This will not be within the next 12months, maybe not even within the next two or three years, but ultimately, the way things are going, this is what we are talking about.
The situation west of the Bann is a massive issue. Many people feel that discrimination is taking place, particularly when one considers that of the "golden circle" of six hospitals, four or five are within a 30-mile radius of Belfast, the other being Altnagelvin in Derry City. If one were to draw a line across the map from Derry, through South Derry, into county Tyrone to the Ballygawley roundabout, one would see that there is not one "golden circle" hospital to deal with the needs of this rural area. There is something badly wrong with that.
I listened with sympathy to what MrMcGimpsey said about maternity services being lost at the Jubilee Hospital, but people in that area can use another hospital 100yards away. However, in the last month maternity services have been withdrawn from the South Tyrone Hospital meaning that people have to travel up to 40miles to Craigavon Hospital.
There is something seriously wrong, and it affects my constituency of Mid Ulster. For example, if there were to be a tragedy in the Pomeroy area, particularly given the state of the roads around Toomebridge — and there will be no bypass there for four or five years — people would have to lie in an ambulance for an hour to an hour and a half. That is absolutely mad, and the sooner Members get to grips with these issues, the sooner the great fears and concerns of our constituents can be dealt with.
I agree with MrMcGimpsey that health boards and the British Government should not be taking decisions on the rundown of services at any of these hospitals until a Health Minister, or Shadow Health Minister, is appointed by the Assembly.
Ultimately, I would like to see all the political parties in the Assembly deal soberly with our many difficulties in a Health Committee. That is a job for us; we will not shirk our responsibilities; and we are not afraid to make unpopular decisions. Weight needs to be given to the views of the tens of thousands of members of the public who are frightened by the way in which they are being treated — their voices are absent from this debate.
The Royal College of Surgeons, the four health boards and the Government need to take on board the views of the elected representatives and the marching feet that we are going to see more of in the coming weeks. People in the South Tyrone area are disgusted at the removal of maternity services in the South Tyrone Hospital, and in the course of the coming months they will see a further debilitating situation developing at their hospitals. We are critical of the rundown in health services and of the way in which the review has taken place.

Lord Alderdice: May I ask you to bring your remarks to a close.

Mr Martin McGuinness: We should also be critical of ourselves, be honest and recognise that we have failed the people — we have not produced a Shadow Minister for Health; and we have not produced a Shadow Committee to deal with health in the Assembly.

Mr Derek Hussey: MrMcGrady talked about being parochial. I intend to be parochial on a specific issue, the major issues having been dealt with well by other Members. I trust that the Minister is aware of the many valid concerns that constituents in West Tyrone and Fermanagh/South Tyrone have about their future health-care —
"a service which guarantees equally high quality care to everyone in NorthernIreland, no matter where they live."
Mr Gibson referred to the closure of hospitals in Castlederg and Strabane, an area which I know well. In that area, there are also many concerns about whether the co-operatives, which local GPs have organised, are operating effectively. People in the area may face journeys of up to 30miles for after-hours services and weekend services. People are also concerned about the Ambulance Service. The crews are doing a great job, but we need to be sure that they are based in the right places to cover the relevant area. Recently, in my area, an ambulance had to travel from Enniskillen to Castlederg in response to a call-out.
The Minister’s report has not "put it right" for those who rely on the services that are provided by the Erne and Tyrone County Hospitals. A lack of vision on the future of these two hospitals has caused great concern among local people. They have been left in limbo, and the report gives a choice of either the Erne Hospital or Tyrone County Hospital.
The report says that decisions of this kind could be made by the Assembly. However, the Assembly could have made a different decision, rather than simply choosing one or other of those hospitals. The Erne and Tyrone County Hospitals are currently run by the Sperrin Lakeland Trust as a combined unit, and together represent the seventh largest hospital unit in NorthernIreland, covering over 20% of the land area of NorthernIreland and providing a service for more than 15% of the population.
I said that I would be parochial on this matter, and that is quite a parish! Demography is more than simply a number of people, and a proper study of the demography of the area should lead to the clear conclusion that to retain only one or other of those hospitals would be inadequate. Mention has been made of the golden six hospitals. Could this not have been the lucky seven?
On page 14 the document states
"While acknowledging the advantages of larger hospitals, these are significantly outweighed by the disadvantages for patients in terms of accessibility."
Why does the report not consider the retention of those two hospitals as a single unit — that is, both hospitals operating together with complementary specialist services available in each, and with accident and emergency services available in the two county towns, Omagh and Enniskillen.

Mr Denis Haughey: I should like also to refer to the situation west of the Bann, and, in particular, to the situation in south and east Tyrone and south Derry. Two of the hospitals which will clearly be affected by these decisions lie in that area, namely in my constituency of Mid Ulster. They are the South Tyrone in Dungannon and the Mid-Ulster in Magherafelt.
We all know that not all of the 17existing acute hospitals will escape change. There has to be change, and change is vital to maintain or improve standards of medical care, and the improvement in the standards of medical care is the most important consideration in this debate. Our citizens are entitled to the very highest quality of service.
However, even though the improvement in medical standards is by far the most important factor in this debate, it is not the only factor. The availability and accessibility of services are also matters of serious concern, as is the best use of existing resources. The integration of Health Service provision into our comprehensive development strategy for the entire region is another concern.
That brings me to my first charge. The Department of Health and Social Services Ministers — not so much MrMcFall, but his predecessors over a period — must stand indicted for their failure to produce a comprehensive strategy for the development of acute service provision in a way that is geographically fair and maximises accessibility and availability.
Only their monumental failure to do so explains how it is that five of the six hospitals that have been chosen to provide the extensive ranges of acute in-patient services form a cluster within a 30-mile radius of Belfast. The sixth one is in Derry city, the farthest point north-west.
I understand and accept the need for a degree of concentration. But concentration on the periphery is not the centralisation of services, which is what the Royal Colleges have called it. The concentration of services in a fair and evenly distributed way across the whole community is what is needed. The Department of Health and Social Services has not devised a strategy for such provision, and it must stand indicted for that.
That brings me to my second, more specific, charge. Over the years, many of us have been critical of the various health and social services boards whose members are unelected. There is a widely-held view that they have shown a good deal of insensitivity to public opinion and to the representations of local politicians. I want to single out the Southern Health and Social Services Board for its recent decision to close the maternity unit in the South Tyrone Hospital in Dungannon, and for the way in which that decision was reached.
For many years, the surgeons in Dungannon have been pleading for the appointment of paediatric consultants to provide cover for its maternity unit. Other hospitals with similar birth rates each year have two or three paediatricians to provide such cover. Board representatives have argued that they made every effort but could not succeed in providing the cover.
Many of those who are close to the hospital and have fought its cause dispute that. The inactivity of the Southern Board over time led inexorably to the situation which arose a couple of weeks ago. Surgeons at the hospital, at long last and quite properly, pointed out that they simply could not carry on without paediatric cover. The reaction of the board was not to provide the cover but to close the unit. I charge the Southern board with contriving to bring about that situation. I believe that it was always its strategy to downgrade or close the South Tyrone Hospital.
The decisions made by the Southern Board over the years which led inexorably to that situation must be intensively scrutinised. Consequently, along with the MP for Fermanagh and South Tyrone, I have initiated a cross-community complaint to the Ombudsman. We invite other MPs and Assembly Members to join us in sponsoring this complaint, and we will make it available in a number of centres in the area served by the South Tyrone Hospital so that the general public may sign.
Unelected quangos should not be immune from being scrutinised by those empowered and equipped to do so. The Department of Health and Social Services should also be made to answer for its failure to produce a fair and equitable strategy for the provision of acute in-patient services in a way that gives reasonable and fair access to the whole of NorthernIreland. They should answer to the charge of conniving at, if not devising the strategy to aggrandise the lucky hospitals which were eventually chosen.
I hope that it will not be long before this Assembly takes on the reins of power; however, it may be February, March or even April before that happens, and a lot of damage can be done in that time. Wrong decisions made by unelected quangos now could cost a lot to put right when it becomes our responsibility to do so, and, therefore, I urge the Minister to freeze any further decision making until this Assembly, through its Minister and its Departmental Committee, has an opportunity to devise a fair and equitable strategy for the delivery of acute in-patient services across the region.

Rev William McCrea: I welcome the Minister but, unlike others, I do not necessarily welcome this document. It has neither the right tenor nor the right agenda for the future of hospital services throughout the Province. Many Members clearly supported the document or rejected it. Some welcomed it; some are sitting smugly because their hospital has been saved or upgraded, and, therefore, this does not bother them. They welcome the approach that has been taken.
Others who represent areas where hospital provision is under serious threat — and this document does nothing to allay those fears — far from being smug, are concerned about the health and welfare of our constituents as we approach the end of this century and go into the next. We approach that next century not with hope, not looking forward to the health provisions that are being made, but with deep concern. I understand those views.
Most people expressed their views very clearly, but I am confused by the representations made by two SinnFéin Members, both from the Mid Ulster constituency. When we read Hansard, I think we will find that one person was saying one thing while the other was saying something else. One was welcoming the document, while the other seemed to have a different opinion. I can assure you that there will be no lack of clarity on my position with regard to Mid Ulster.
This document is not ill-prepared, as some Members have suggested. Its agenda for the future of hospital services is very clear, and I do not accept it. I had the privilege of representing the district of Omagh and the Tyrone County Hospital when it was in the former Mid Ulster constituency. I saw maternity services withdrawn from the Tyrone County Hospital, and I genuinely believe that that was an injustice to the people of Omagh — an injustice that needs to be put right. Those services were not necessarily removed on medical grounds.
If it could have been justified, I was certainly open to persuasion, but on top of everything else there was a concerted effort of political manoeuvring, and the people of Omagh have paid the price for that manoeuvring: the loss of their maternity services. I wish the Tyrone County well in its efforts to ensure a solid future for that area, because it has a vital role to play in the future of Health Service provision for that rural community.
In the document ‘Putting it Right’ the Minister, and those who prepared it, have made sweeping and idealistic statements about the provision of modern and effective hospital services. We are informed that the Minister wants
"a service which guarantees equally high quality care to everyone in Northern Ireland, no matter where they live."
That sounds good — a sweeping statement: "no matter where they live." Members who read the document carefully will notice that that phrase occurs over and over again, as if that was what this document was going to bring about. I suggest that it is doing the very opposite. It is not giving equally high quality care to people throughout NorthernIreland. How can such a statement be justified when, in reality, the changes that are being suggested will remove or change in one fell swoop 60% of the acute hospital services currently provided.
Equality of service also involves equality of accessibility. The time taken to get to high quality care can be a matter of life and death. Why should we accept, west of the Bann, the destruction of the excellent acute services that we already have at the Mid-Ulster and South Tyrone Hospitals, and thereby risk the lives of our constituents? The Minister is proposing to give us far less than we have enjoyed until now, and far less than is enjoyed by the rest of the Province. That is totally unacceptable to my constituents.
There is no pressure whatsoever from the community to downgrade the acute services at the Mid-Ulster or the South Tyrone. The very opposite is the truth — 30,000people came onto the streets to oppose such action. Surely that is the community saying "No" loudly and clearly to downgrading and to the withdrawal of maternity services from the South Tyrone.
And yet this document suggests that the community will not allow the present situation to go on. The truth of the matter is that the community is demanding that local acute services be provided close to the community, bearing in mind the vastness of the rural area that we are talking about. This document is saying that if you get sick, race as quickly as you can to the east of the Province before it gets dangerous. Best of all, do not get sick west of the Bann, for you are sure to die. That is ridiculous. What way is that for a health service to look after the people of an area? The Minister may think that that is funny, but let us take a look at the map and talk about geographical accessibility.
Let me give an example. At the weekend no beds were available in Belfast hospitals. One patient was sent from the verge of the city to the Mid-Ulster Hospital in Magherafelt. His wife paid a £42 taxi fare to visit him. Today, the consultant decided that the man was able to go home, but the trust concerned was unwilling to provide an ambulance. He was told that he could don his pyjamas and an overcoat and get on a bus. He would have had to travel in to the centre of Belfast and then get a connection to his home in Newtownabbey.
So his wife had to pay another £42to collect her husband from that hospital today and take him home. She had to pay a total of £84inside three days. Do Members realise that this is an example of the caring service that we are going to have in the future? They are taking the service from the local community. People are having to travel to the service. Is the answer to make it as comfortable as possible for the Royal College and consultant to guard their time at the expense of the ordinary members of the community? This is an example of what is in store for people in the rural areas of this Province, if the six golden hospitals receive the approval of the Assembly.
I ask the Minister and his Department to ensure that the Assembly is free to take this decision without any predetermined plan being put into operation, such as happens with non-elected quangos which make certain outcomes inevitable. Any independent assessment of the position of the new six golden acute hospitals shows that the rural area west of the Bann is not only disadvantaged,

Lord Alderdice: Could you please bring your remarks to a close.

Rev William McCrea: but discriminated against. We have to look carefully at the provision of health services, not because of the pressure from the British Medical Association or the Royal Colleges, but because this document says that the number should decrease from six to three. We are on a roller-coaster towards contracting the service even further, and those who are sitting smugly today had better realise that if they yield to the pressure of these professionals their hospital will be under threat as well.
I ask the Minister to stop travelling along the road that he and his Department are on and to allow the Assembly, unshackled by the decisions of unelected boards, to make the decisions about future health provision.

Ms Mary Nelis: Go raibh maith agat. Willie, I might give you a third position and confuse you entirely.
Mr McFall is very welcome, and I want to thank him for presenting us with this document, a document that needs very careful scrutiny. None of us would disagree with the mission statement of ‘Making it Happen’ which promises to provide us with a modern, effective hospital service and primary care through a community health service which guarantees equally high quality care to everyone.
I do not know who advised the Minister, but I believe that this paper has not been properly thought out and that the case for change has not been properly made. The Western Board Acute Services Review Committee which has many sub-groups and an extensive consultation programme is not due to report until 1999. ‘Putting it Right’ upstages that consultation process, and I wonder whether those engaged in it will have to repeat the exercise.
I welcome the fact that the Minister is endeavouring to address the crisis in Health Service delivery. Market forces dictate health services. Patients are now referred to as clients, and hospitals are coming down with men — and a few women — carrying briefcases. One of the key issues in the document is the Ambulance Service. I welcome the injection of much-needed cash to the Ambulance Service, but I hope that it is not at the expense of downgrading some of our area hospitals. I am concerned that the paper is preoccupied with the notion that big is beautiful. "Big" in terms of hospitals and ‘Making it Happen’ seems to refer not to the golden six as WillieMcCrea says, but to the golden two. Excellent hospitals they may be with excellent staff and facilities — I am talking about the Royal and the City — but they are within an area which does not provide services to the majority of people west of the Bann.
I hope that the Ambulance Service review will address the crisis in the service which has always been the Cinderella of the entire Health Service. In Derry City, where I live, ambulance crews have to cover not only the entire city and the surrounding areas, but are constantly on call to deal with transfers to Belfast. That is because Altnagelvin was not given proper financial and medical resources to treat many serious illnesses.
Frequently, only one ambulance crew is left to service Altnagelvin, which is supposed to be an acute hospital. Last year in our city there was a serious housefire in which parents and two children died because there were not enough ambulances to transfer them to hospital. When another ambulance eventually arrived, the crew attempted to revive people, but without success. Others had to be driven to hospital by a policewoman. This is not an isolated incident. In the Western area many patients regularly have to be transferred to hospitals by taxis and other vehicles.
There is no point in having the best facilities at hospitals if patients cannot get to them. I welcome the review, but I am also concerned that the review body was rather exclusive. For example, it did not include trade union members or members of the health councils, although such people have hands-on experience of the Ambulance Service and certainly would have had a good input to the review.
Some Members raised concerns about the closure or run-down of maternity services and units. That issue is insufficiently addressed in the document. Women who are fortunate enough to live near a hospital where maternity services have not closed are being discharged from hospital some six hours after giving birth. We are all familiar with the case of the woman who gave birth about two years ago in her husband’s lorry en route from Omagh to Altnagelvin while stuck behind a tractor in a queue of traffic.
We know of the woman who almost died in similar circumstances with a postpartum haemorrhage. The maternity services look like replacing the ambulance services as the Cinderella of the Health Service. A review of the maternity service is needed.
There are other concerns, such as the training of highly specialised nurses, who then leave because they cannot get a contract, and the managerial structure of hospitals. A theatre porter recently told me that he had seven superiors. The issue of trust executives is scandalous. They have salaries of £92,000per year while nurses, porters, auxiliaries, canteen and cleaning staff are all expected to live on wages that are well below the poverty level. I urge the Minister to give more consideration to this document. I support the calls that no decision be made until the Assembly shadow Executive and Ministers are in place and we have had further time to discuss the issue.

Mr Kieran McCarthy: I wish to thank the Minister and his Department for the very sensible decision that they made on the funding of the three integrated colleges last week. When other Members and I met with the Minister about the matter I asked that he give us a good Christmas present. I am delighted that he did.

Lord Alderdice: Your comments are outside the bounds of this debate.

Mr Kieran McCarthy: I was expecting that.
I have a few comments to make about the document today. I welcome the references on pages3 and 11 to the fact that patients are entitled to to receive the right treatment in the right place at the right time, delivered by the right person. No one in this Chamber could possibly disagree with those sentiments, but how can we achieve such a goal? There are many ideas and suggestions in the Minister’s document, and I hope that it contains the answer we are looking for.
On page 5 the document, under the heading "Why Change is Necessary", says
"Services in some smaller hospitals are being stretched to breaking point. Some patients are currently being admitted to hospitals that are not adequately equipped to provide the full range of tests and support they need."
How right that is.
The Ulster Hospital at Dundonald, which is one of the major hospitals, has frequently been at breaking point. Patients have had to endure the indignity of lying not on a bed but on a trolley, and not in a ward but in a corridor, for many hours. On occasions, because of the lack of attention, patients were taken home to receive some form of comfort. This cannot be tolerated. The Strangford constituency, which includes the tip of the Ards peninsula, expects, and must have, better. The sooner improvements can be made at the UlsterHospital the better.
The sooner that improvements at the UlsterHospital can be made the better. I pay tribute to the dedicated staff of that hospital, who work under tremendously stressful conditions. We can only hope that their lot will be dramatically improved.
The document mentions the new community hospitals in Newtownards and Bangor. I welcome those developments, which are a response to the withdrawal of acute services from Newtownards and Bangor some years ago. I appreciate the co-operation of all those who were concerned in those ventures, particularly our local general practitioners.
If community hospitals are used and managed properly, our people will enjoy better health provision. The development of a highly effective ambulance service is vital for people in rural areas. Those living on the Ards peninsula could be facilitated with an ambulance out-service in the centre of the region. I thank the Minister for the document. Things can only get better, and the new Assembly will put matters right, provided it is given the necessary funding.

Mr Roger Hutchinson: I thank the Minister for taking time to speak to the Assembly. My colleague MrBoyd and I met the Minister on 19 October. At the meeting I put the case of a constituent, MrCowden, to the Minister. MrCowden’s wife had been admitted to the Broadways Nursing Home in Larne. MrCowden was in another Fold and wanted to be with his wife. The Minister looked into the matter, and on 28October MrCowden was moved to the Broadways Nursing Home to be with his wife. Sadly, MrCowden survived for only four weeks. At least he was able to have four weeks with his wife, and I want to put on record my thanks to the Minister for his help.
There are many good things and many bad things in the report. I represent East Antrim, and I have some concerns about the rural part of my constituency. It is difficult for people living in Islandmagee to get to Whiteabbey Hospital. If the Minister’s proposals for that hospital go ahead, the majority of patients will have to travel to Antrim area hospital. Many of the proposals in the Government paper rely on a good Ambulance Service. I ask the Minister to reconsider his plans for Whiteabbey Hospital. Perhaps, as my colleague MrBoyd so ably put it, the Minister should listen to people in the area.
An ambulance service is central to the Minister’s paper and his plans. I do not know whether the Minister is aware that an ambulance in Larne with the highest mileage in the Province has broken down on several occasions and left people stranded. This is not an adequate service, and I am delighted that £15million will be put into the Ambulance Service, which is central to the working of the new organisation.
As there is only one ambulance crew, no one should take ill on a Sunday or Monday night in Larne. Should there be an emergency in Ballymena or in any other area within the constituency, the ambulance crew has to go there first. Therefore, if you take sick you have to wait for the ambulance to return. That is not an adequate service for the people of east Antrim. I ask the Minister to examine the situation.
The Ambulance Service and the Northern Health Board have promised me that Larne will have two new ambulances by the end of December. Perhaps the Minister will check to make sure that that happens.
It is harrowing to be approached by the families of mentally handicapped or disturbed people in Muckamore Abbey. Some of them have been there for 30 or 40years, and it is sad for their relatives to see them put out to be looked after in the community after such a long and happy time in a place which has become their home. The families did not put them there because they did not love them or were embarrassed by them. They put them there because the care in Muckamore Abbey is second to none. I pay tribute to the doctors and the nursing staff who deserve better treatment than the proposals suggest. I would ask the Minister to rethink some of the proposals for Muckamore Abbey.

Rev Robert Coulter: I welcome the Minister to the Assembly. I am sure that after 17speakers he will agree with the philosophy of HenryFord, who said
"The longer the spoke, the greater the tyre."
Much has been covered already, but I should like to ask the Minister about the philosophy of the analysis. Who were the members of the team involved in this? Many of the gaps in the analysis have been pointed out, but I am concerned that my constituency is not mentioned and there will not be a local hospital in the constituency of North Antrim.
Ballymena hospital has been closed, and Moyle, Ballycastle and Ballymoney hospitals are not mentioned, yet the core philosophy of the analysis is that people will get quality care no matter where they live. Local hospitals offer valuable short-term respite and palliative care to allow patients to recover following surgery or illness. How can that happen in North Antrim? Patients would be treated at the acute hospitals, but could not return to a local hospital for further recovery time. Where do the patients of North Antrim go when they have no local hospital?
Ballymena Borough Council has been arguing since the Waveney Hospital closed for a minor accident and emergency unit in the town because if a child cuts his finger in school, two teachers have to go with him to Antrim. However, as it is not a serious injury the child has to sit there for approximately four hours before the injury is attended to. That means that two teachers are out of school for half a day, which is a loss of their valuable services to the pupils. When the hospital trust’s board members talked to the council about this matter, they told us that we had to decide whether to have cancer care in Antrim or a minor accident unit in Ballymena. It is totally unfair for any board member to ask that of a locally elected representative. That is a decision for the board.
Does this document state that that kind of charade will not go on in future? Can we take it that there will be adequate representation on the boards? I ask this because the only member of the United Hospital Trust’s Board who has any contact with Ballymena has "formerly Ballymena" in brackets after his name. Why are the other members not "formerly Belfast" or "formerly Newtownabbey"? There is no one on that board from the Ballymena area.
There are many other matters that I could raise, but I want to draw to the Minister’s attention the fact that this document proposes that Ballymena lose its last service. It says
"Some changes to services in Ballymena are proposed. Assessment and rehabilitation services for older people, together with dedicated stroke and orthogeriatric services presently at Braid Valley Hospital, would be centred at the Antrim Hospital."
NorthAntrim in its entirety is to be bereft of any of the services proposed in this document. What is the philosophy behind the analysis? Who took the decision on that? Will there be adequate discussions with us before we proceed further with any decisions along that line?

Dr Alasdair McDonnell: I thank MrMcFall for his attendance, for his interest and for the extra funding that has been announced. In doing so, I also want to endorse MrCoulter’s comments. As a son of north Antrim, I agree with him that it is time the constituency had a new MP because it has been politically neglected all these years.
I should like to deal with the important issue of the crisis in the Health Service and the response to ‘Putting It Right’. A forthcoming report from the four Colleges of Surgeons in England, Ireland, Scotland, and Wales was leaked to a newspaper last week. The report, if true, certainly indicates that we are in crisis. According to that report, only four of 17acute hospitals meet clinical standards. The article stated that because of those failing standards, recognition and junior staff will be withdrawn and the hospitals will be clinically paralysed.
This debate has come at an appropriate time. We need to get to grips with the broad web of crucial issues affecting the Health Service. Time and time again we receive contradictory documents. The current document is certainly acceptable and reasonable and makes a contribution, but it follows the recent ‘Fit For Nothing’ document, which had a totally different angle.
A total lack of clear vision on the overall provision of health care is the greatest problem. We need a clear set of objectives and practical targets — markers or baselines against which we can measure achievements. The shifting goal posts have been referred to time and time again in the debate. The goal posts are on wheels, and you are never quite sure where you are going to kick the next time — they are going round and round until some of us are dizzy.
Could the Minister tell us whether we in Northern Ireland are to have a disease service or a health service? This is a fundamental question. Is the Health Service here to cure or to try to stall disease for as long as possible, or is there to be a realistic Health Service in the twenty-first century meaning of the word? If the Department of Health and Social Services is engaged in rationing health care, the Department should say so openly and not leave it to the lengthening hospital queues and to the GPs like myself at the coalface to try to stretch £100million of funding to get £120 million worth of work. You can stretch it a bit around the edges, but it will not stretch that far.
In the context of the rationing that is taking place, the Department of Health and Social Services must stop creating limitless public expectations in the face of very significant constraints, because the two just do not fit. We should not have a situation in which the sky is the limit in terms of what people are entitled to when we do not have enough money or enough people to deliver such a service. Until the Government put real effort and money instead of lip service into new technology and telemedicine, the efforts of GPs will be wasted.
NorthernIreland will remain in a backwater while everywhere else in the world is at the cutting-edge of technology and facing twenty-first century problems with that new technology. The Government must stop making simple things complicated, and in many cases a very simple problem is turned into a very complicated one. The Government have to stop creating artificial obstacles merely to protect vested self-interest — and there is a lot of that around. That creates problems, and the Government have to deal with it.
The Government need an open and honest leadership to drive this health agenda forward. At present it is unclear what or who, if anyone, is setting the agenda. It is all piecemeal, and the Government must decide whether it is the Department of Health and Social Services, the medical profession, the administrators, financial constraints, social services or political considerations that decide policy.
The Assembly should not have to spend the next 10years debating structures, administrators and mechanics and paying very limited attention to clinical standards or popular choice. People are entitled to some choice. Members have to decide if personal choice, people’s feelings and clinical standards are more important than structures.
While I do not agree with all the details of ‘Putting it Right’, I welcome the publication because it has opened up a debate on the Health Service. However, these proposals were rushed out in a pre-emptive response to offset the negative report coming from the College of Surgeons. The Department of Health and Social Services is not on top of the situation, and it needs to get on top of it. This debate affords Members the opportunity to begin to focus on, and get to grips with, all the complexities in the health and care services. Major decisions need to be taken to improve the well-being of all our communities, and hospitals are a central element of this service. But before dealing with hospitals I would like to touch on a couple of other points.
It is essential to have a policy that is comprehensive and provides for a totally integrated approach to health and social care. When I use the word "comprehensive", I have in mind, and I mean, a holistic and proactive approach to health and well-being: an approach led from primary care; an approach led at the simplest level; and an approach led from the ground up but designed both to prevent and to cure illness, with the emphasis on prevention.
Health promotion and disease prevention must be at the core of any Health Service of any distinction. If a more effective preventative strategy existed, there would be fewer people in hospital. The Health Service is impotent, as far as I can see, in the whole campaign on health promotion. We are all aware of the lethal impact of cigarette smoking on health and its well-proven links with cancer and heart disease.
We should be aware of the massive cost to the economy generally and to the Health Service specifically of alcohol abuse, but little or nothing has been done about that. Time does not permit me to go into detail, but I again emphasise that tobacco kills one in six of our population, and is responsible for more than 90% of lung cancer deaths.
Last year in Northern Ireland 773people died from lung cancer. Those are the ones we know about, and they did not need to die. They could have lived another 10years. I have noted in my own practice that people who smoke normally die 12 to 15years earlier than their non-smoking brothers and sisters. The useful economic activity that is lost when they die is just the tip of the iceberg. Massive morbidity is associated with smoking.
Time does not permit a listing of chronic ill health. Some 25% of hospital beds are occupied every winter because of chronic bronchitis and emphysema, both of which are smoking related. Those issues need to be dealt with. There is no point in having a disease service that provides hospital beds for people who have smoked themselves almost to death. There is no point in providing such people with death grants. That would be not a Health Service but a disease service.
Prevention is essential, and it is not just an individual responsibility. Prevention of illness and the promotion of good health are the collective responsibility of everyone in Government. Central Government has a key role and a moral responsibility in the wider context to pursue policies and strategies that promote and ensure good health. Promoting healthy living and ensuring a framework of attitudes, laws, rules, regulations and policies that enable people to follow a healthy lifestyle must be an essential part of any health care programme.
One would think that the debate was on hospitals rather than on the Health Service. The Health Service began and ended with hospitals. Joe Hendron said that 90% of health care is provided at primary level, and it is important to realise that that is where all the work is done.

Lord Alderdice: Please bring your remarks to a close.

Dr Alasdair McDonnell: When considering the Health Service and the role and potential of hospitals, we must also consider primary care. There must be scope for GPs to work closely with hospitals. Can new technology and tele-medicine not be made to work for us by linking peripheral GPs to district hospitals, and by linking GPs and district hospitals to area and regional hospitals?
We should be able to bring first-class care and service to places as peripheral as Belleek and Garrison.

Lord Alderdice: I must ask you to bring your remarks to a close.

Dr Alasdair McDonnell: There must be deeper debate on health. Overall vision is lacking, and the tension surrounding the provision of hospital services arises because people believe that they are losing a service, and that there is nothing to put in its place.

Lord Alderdice: I must ask you to bring your remarks to a close.

Mr Maurice Morrow: I welcome MrMcFall to the Assembly. I am not enthusiastic about his document, but that is understandable because I am a rural dweller with a rural constituency. The document shows that rural dwellers will soon be second-class citizens in the Health Service.
The Minister stated that the future of the Health Service would be one of the greatest challenges facing this Assembly, and that may well prove to be true. However, by the time that the Assembly is in a position to address this issue, far-reaching decisions will already have been taken. Guidelines in the ‘Putting It Right’ document lead inevitably to one conclusion. According to the document and the Minister, none of our hospitals will close. They will not close today, but it will be death by a thousand cuts.
The strategy document concentrates on the golden six which are in the populated areas of Northern Ireland. Those of us who live in, and represent, rural constituencies will not fare so well. Those living in rural areas are fast becoming second-class citizens in terms of health-care. The document states that smaller hospitals are being stretched to breaking point and then proceeds to recommend withdrawal of certain services. The SouthTyrone Hospital has recently had maternity services withdrawn and the rundown is well and truly under way.
Over the years the medical and ancillary staff in the SouthTyrone Hospital have done an outstanding job. Page 9 of the document states
"Patients must be treated by properly trained doctors."
Does this imply that this has not been the case in the past? If hospitals continue to be run down, it will be very difficult to attract staff to work in them.
The document, on page 11, says
"Patients want to be treated close to home."
That will not happen as a result of this document, not in my area anyway. Local hospitals will constantly be under threat and resources will be concentrated on the golden six. RevWilliamMcCrea touched on the real point when he cited the fact that there are three hospitals in this document. Members across the Assembly smiled when he said that, but in years to come he will be shown to have been correct.
I would draw the Minister’s attention to a recent incident when a critically ill cancer patient had to wait two and a half hours to be collected from his home in Fivemiletown to be taken by ambulance to the Erne Hospital because Fivemiletown is situated between Enniskillen and Dungannon. This document severely disadvantages communities in rural areas, like the Clogher Valley. The rundown of rural hospitals will also result in a substantial loss of jobs. It is estimated that 200 jobs could be lost in the Dungannon area as a result of the removal of maternity services. This document does not adequately recognise rural communities.
I would like the Minister to take on board what I consider to be a glaring omission — there is no mention of an Information Technology infrastructure to service the various hospitals and primary-care centres. A patient was given a scan in a local hospital but, as it could not be interpreted, the patient had to go to the Royal on a six-month appointment. He had the same scan on an identical machine and had to go to the seventh floor and wait one and a half hours. A consultant then gave an interpretation which was identical to that given six months earlier. On enquiry there was a refusal to operate a simple fax machine. If the Minister cannot reply on this point today, perhaps he could reply in writing.

Mr Mick Murphy: Go raibh maith agat a Chathaoirligh. I also welcome the Minister. The document ‘Putting It Right’ is exciting and challenging. We do not have the option to wait until a new Minister is appointed before we tackle this issue, as hospital services are facing a critical time.
The Health Service is facing a critical period, caused by the decisions made by the current British Government. There is widespread unease in local communities about cut-backs and the general rundown of local hospital services. It would have been better if the Minister had introduced these plans before the general rundown of acute services began. It is a fact that a wide range of services in smaller hospitals are being stretched to breaking point. Nevertheless, I would like to take this opportunity to pay tribute to the services which these hospitals have provided over the years.
The Minister will claim that the standard of care in some of these hospitals is not as good as it should be, but the fault lies with MrMcFall and his predecessors who have failed to make the necessary resources available. We need a regional investment plan, to be drawn up as soon as possible, to ensure that the proposed capital developments will result in hospitals adequately equipped to deliver acute services.
On behalf of my local hospital, Daisy Hill Hospital in Newry — mentioned on page 29 of the document — I appeal to the Southern Health and Social Services Board to appoint an accident and emergency consultant as a matter of urgency. Daisy Hill Hospital urgently needs a CT scanner for its accident and emergency department, and I call on the board to invest in the necessary facilities. I call on GPs and hospital managers to work together to ensure that all the services outlined on page 29 of the report are provided. A cross-border body should be established to take account of the fact that the population of northLouth also lives in the catchment area of the hospital.
I am delighted to see that there has been investment in the Ambulance Service, but, in order for this service to be fully effective, we need better roads. The Department of the Environment and the Department of Health and Social Services should work together to ensure that the road network in south Down and south Armagh is improved substantially, and should do this as part of an integrated plan for the area. If the Downe Hospital is to be closed down, the roads must be updated so that the Ambulance Service can provide patients with the service that they need but for which they now have to travel considerable distances.

Mr Jim Wilson: I thank the Minister for coming here today to hear our views. Today’s bulletin from the NorthernIreland Information Service, under the heading Mental Health and Learning Disability Services, states
"We [the Government] are committed to the development and improvement of services for people with a mental illness or learning disability, particularly to allow people the dignity to live as individuals in community settings rather than be lost souls in large and impersonal institutions."
I note also that the Government are allocating £5million, in addition to the £25million already allocated, to the community-care budget, to enable boards to meet particular pressures in their areas. I welcome that.
However, I have received a fax today from the North and West Belfast and Muckamore Abbey Branch of the public service union, UNISON, which says that residents in Muckamore Abbey are unhappy, and in some cases suffering, because reprofiling in its current form has not been a success.
It says that staffing levels cannot be maintained because of the £491,000 which has been taken out of the Muckamore Abbey budget and that this poses a serious risk to residents, as well as a drop in professional standards of care. It goes on to say that there is a serious risk of more upheaval to accommodate more ward closures in the future.
Further, the union says that the trust’s chief executive has instructed the site director to dispose of 40 members of staff, disregarding the fact that this will pose a serious risk to the welfare of the hospital’s patients. Finally, and this is very important, it says that there are, as predicted, mixed-gender wards and unsuitable groups living in care together.
Given that situation, does the Minister accept that there are, unfortunately, people living in institutions who could not and should not go out to live in the community? Can he assure the Assembly that some money will be directed to those institutions, such as Muckamore Abbey in my constituency, so that the patients to whom I refer can live and enjoy the same dignity inside the institutions as others living with their families in the community?

Ms Patricia Lewsley: I welcome the Minister and the opportunity to speak in this debate.
I want to raise the matter of the Lagan Valley Hospital in my constituency, which MrClose has referred to. The Minister’s vision for the future sees Lagan Valley as a local hospital, but I see it as more than that. When the decision is finally made on area hospitals, and specifically on Belfast City and the Royal Group, what will be the possibilities for local hospitals to facilitate area hospitals in the medium-to-long term?
The Lagan Valley Hospital is in a unique position, being close to the motorway, with easy parking access and upgraded ward facilities. It could form a partnership with the area hospital by providing, for example, day procedures and elective work, thus lightening the load of the area hospitals which, in the medium term, will be experiencing a severe workload.
I hope that the majority of accident-and-emergency and midwifery services will be kept in the Lagan Valley Hospital, especially given the fact that its maternity services were awarded a Charter Mark in 1997. This, of course, can only happen with adequate consultancy back-up and, I hope, with the expansion of the new telemedicine in the near future.
Many of us are very conscious of the need for a better Ambulance Service, which is vital to ensure that people in all rural areas, including part of Lagan Valley, get as high a standard of care as those in the urban areas. It is important that the Ambulance Service work in partnership with the local hospitals.
These are just a few of the benefits which Lagan Valley Hospital can offer to complement the area hospitals and provide a better service for patients in the local and wider communities.

Mr Jim Wells: I welcome Mr McFall’s visit here today, and I want to thank him for taking the health spokesmen of the parties into his confidence before he launched this document. That is a very welcome trend, and one that I hope will continue.
There is a mythical conveyor belt heading towards one Assemblyman, and on that conveyor belt is the ultimate poisoned chalice, stamped "Minister of Health and Social Services". Someone in this Chamber will drink from that chalice, and I do not envy him or her that predicament. It won’t be me.
We have heard a lot this afternoon about the various colleges. Down District Council, in its response to the Minister’s decision — that Minister being MrWorthington — on the future of Downe Hospital, pointed out that the colleges do not all agree on this issue. After the Minister took that decision, the report of a joint working party was published which made interesting reading. The Department does not seem to have taken the joint working party’s recommendations into account when coming to the decisions outlined for Downe in this document.
One of the conclusions in that report was that in America 50% of all graduate doctors are being encouraged to specialise in general medicine. They think the trend towards specialisation has gone too far, and they are hoping to have half the qualified doctors performing a general surgical role rather than specialising. The report argues that often, and particularly with elderly patients, a patient has a wide range of complaints. What that person needs is to be treated not by a series of specialists, but by someone who has a general training and can call upon a specialist if needs be. It is better for a person to be taught by someone with a much wider knowledge.
We can quote the surgeons, but they do not agree. Even if they did agree, this process should not be driven entirely by the Royal Colleges. There are many things in life which seem to need specialisation or concentration, but that takes no account of the needs of the ordinary, individual patient. We could concentrate many services in NorthernIreland on one or two major facilities — education is the obvious example. There would be logic behind a proposal to concentrate the teaching of a certain language or subject in one school in the Province, but that would take no account of those who live in rural areas.
The question I ask is one which no one has satisfactorily answered: does someone who falls and breaks his leg in MainStreet, Strangford get the same treatment as someone who breaks his leg in RoyalAvenue in Belfast? The answer must be "No." The patient in Strangford has to be ferried to Downpatrick, but instead of being taken to Downe Hospital, under these proposals, he would then have to make the 30-mile trip to the City or the Royal in Belfast.
I know that the Minister has a chauffeur-driven car — I would love to have one myself, but I never will; Back-Benchers do not get chauffeur-driven cars — but has he ever tried driving from Ardglass or Killough to Belfast on a wet Saturday night in November or December? Has he ever tried that? Does he see how practical, or otherwise, the proposal is that a person who has had a serious accident or a heart attack in a rural area should be driven to Belfast?
Unfortunately, traffic in Belfast is now utterly horrendous at night, particularly during the rush hour between four and six, and in the mornings. Even during the day there are long queues. It would be physically impossible for an ambulance to get through. And yet, the Minister says in this document that he is putting the care in the right place at the right time. I simply cannot accept that. If he can convince us, in the few short months before he hands over the poisoned chalice, that that person will be getting the right treatment in the right place at the right time, I will be the first to admit that I was wrong.
The community that I represent in South Down thinks quite the opposite. The local GPs want acute services retained at Downe, and the surgeons want to retain those specialties in Downe Hospital. A major selling exercise would have to be done before anyone would be convinced that the best interests of the people in Down district are not served by the retention of the acute services at that hospital.
It is recognised in the document that accessibility is an important issue, that it is impossible to expect somebody from Strabane or Omagh to be ferried to Belfast. The same conclusions can be reached when considering Downe Hospital because of the rural nature of that part of the constituency of South Down. The same criteria should be used when considering that hospital.

Ms Bairbre de Brún: Ba mhaith liomsa chomh maith fáilte a chur roimh an Aire inniu, agus ba mhaith liom chomh maith fáiltiú roimh an phlépháipéar agus roimh an deis a tugadh dúinn todhchaí na n-otharlann agus na ngéar-sheirbhísí sláinte eile a phlé.
Mar a dúirt baill eile den Tionól seo romham, tá ceisteanna deacra le freagairt, agus cinneadh ollmhór le déanamh againn uilig amach anseo.
Aontaím go gcaithfidh seirbhísí a bheith fiúntach ó thaobh costais de. Caithfimid bheith in ann caighdeán ard seirbhíse a chur ar fáil chomh maith. Is gá, mar sin, moltaí a aimsiú a chomhlíonann na critéir sin. Caithfidh na moltaí bheith raidiciúil.
Cé go n-aontaím go gcaithfear pleananna s’againn a thomhas ó thaobh costais de, ní féidir an cheist sin a chur sa chéad áit mar phríomhphrionsabal. Bá chóir tús áite a thabhairt do riachtanais ár muintire uile.
Fáiltím roimh an ráiteas ón aire inniu nach mbaineann moltaí s’aige le gearradh siar ar chaiteachas.
Cibé cinneadh a dhéanann an Tionól seo maidir leis na seirbhísí sláinte, tá sé rí-thábhachtach nach do chostas amháin a thugtar tús áite.
Deirtear sa cháipéis go mbeidh cuid de na h-otharlanna áitiúla in ann seirbhís níos ginearálta a chur ar fáil: i gCúl Raithin, in lúr Cinn Trá agus i ndeisceart Bhord an Iarthair. Is léir go dtuigeann an t-aire tábhacht na gceanntracha sin, agus labhair an t-Uas Foster agus baill Tionóil eile nach é ní ba luaithe ar riachtanais muintir a ndáilcheantair féin.
Dá thairbhe sin, caithfimid amharc arís ar liosta na n-otharlann ar cuireadh an "ciorcal órga" orthu le cinntiú go bhfuil an t-seirbhís cheart á riar ar an phobal san áit cheart.
Agus caithfimid cinntiú go bhfuil coiste feidhmiúcháin curtha ar bun go práinneach sa Tionól seo le go dtig linn uilig an t-seirbhís atá de dhíth orainn a chur ar fáil don phobal s’againn go luath.
I would also like to welcome the Minister here today. I welcome the paper and the opportunity to discuss the future of the hospitals and acute services. As other Members have said, there are hard questions to be answered and major decisions to be taken by us all.
I agree that services must be cost-effective, that they must deliver a high standard of service and that they must be able to meet the needs of the whole community. Proposals which meet these criteria must, therefore, be identified and put in to practice. They need to be radical and far-reaching. While any proposals need to be measured against cost, this must not become the overriding principle. The health needs of people, particularly when it comes to acute services, must always be paramount. It is vital that when the Assembly comes to take decisions on this question, cost-effectiveness should not take precedence in respect of the provision of health services.
I note that it also states in the document that some smaller hospitals will be able to provide more general acute services in Coleraine, Newry and the southern part of the Western Board. MrFoster and other Members spoke very eloquently about the needs of their constituents. We must look again at the list of the golden six hospitals to ensure that the right number are providing the right service, in the right place, to the right people. When we look at the provision of services all these questions will need to be taken into account.
An executive committee must be established urgently so that the service which is so badly needed by everybody can be provided.

Lord Alderdice: We are due to finish at 6o’clock, thereby allowing four hours for this debate. Should the House wish to proceed with the remainder of the Order Paper, I have enough Members — many of whom have been waiting for a very long time — to take us two and a half hours beyond 6o’clock. I propose, therefore, to remain faithful to the existing arrangement and limit the debate to four hours.
Other business has been identified for tomorrow, and this is likely to mean that a substantial number of Members who wish to speak are going to be unable to do so. For the remainder of the time available, Members will be given the opportunity to speak for a time proportionate to the size of their parties.
Although it will be a matter for the business of the House, it seems to me that health issues will require substantial attention at an early stage. For now, it is important that we adhere to our time constraints.

Mr P J Bradley: Will the Minister accept a written presentation?

Lord Alderdice: That is a question for the Minister, but he has indicated that he is eager to receive Assembly Members’ representations. If matters have been raised to which he has been unable to respond verbally, I believe that he will be prepared to reply in writing. With regard to matters not raised because Members did not have the opportunity to speak, I feel certain that the Minister will try to respond.

Mr George Savage: I too wish to welcome the Minister, but for a reason quite different from that of some other Members. I represent Craigavon, and I am glad to see that Craigavon Hospital has been elevated into a different category.
Earlier, my good friend, RevWilliamMcCrea, said that I was sitting here smugly. That may be so, but I am very concerned about the possibility of hospital closures. I was in Craigavon Hospital a few weeks ago as a patient and had to sit for an hour and a half.
I am very concerned about the extra burdens that are going to be put on hospital staff, and would like to pay tribute to those staff who have been working under difficult circumstances and a great deal of stress, not knowing which category their hospital is to be slotted into. Staff in these hospitals face a huge challenge, because so much is being asked of them. We all know that young doctors want to be trained in a big catchment area; it may be the same in respect of nurses. We must recognise the challenge facing the nurses and provide them with an incentive to carry out their work.
A number of months ago, it was brought to my attention that there was an advertisement in the local press for people to work on bin lorries. Another advertisement which appeared was for a trained nurse in a specialised post. It was noticeable that the assistants on the bin lorries were being paid more than the trained nurses. There is something wrong with that; we cannot do without nurses, and they must be given every incentive.
I have watched Craigavon Hospital develop over the years into one of the major hospitals in Northern Ireland. I sympathise with people whose area hospitals have closed over the years. Just 18months ago the Banbridge Hospital closed, and that was a big drawback in the Upper Bann constituency.
People do not like change but change will come anyway, so we must face up to it. I am glad that the Ambulance Service is going to get a boost — it certainly needs it. I hope that money is provided to bring the service up to date. One Member mentioned that some ambulances have been is use for so long that they are well past their sell-by date. We cannot expect ambulance drivers to carry out the work unless they have the appropriate equipment.
I am glad that Craigavon Hospital is safe. I also face the challenge — and I speak for quite a number of the people in Craigavon Hospital — of dealing with the extra burden that is going to be placed on us.

Mr Tommy Gallagher: I also want to express my appreciation to the Minister for the time that he has devoted to the discussion this afternoon. He has, during the course of the discussion, heard many views from the west of the Province and, as the Member from the most westerly part of the North of Ireland, I want to speak particularly about provision there. I want to put forward the views of the elected representatives in the various councils with regard to hospital provision and to express some reservations about the document’s references to the Ambulance Service and to the need for an improved network for GPs. I am not simply moaning about the situation — I am trying to put across the very genuine concerns and fears that people living there have about the issue of accessibility.
In the west of the Province the population density is one quarter of the average for NorthernIreland, and the provision of health and hospital services requires very careful consideration as the people who live there are scattered across a very large area. Unfortunately, this aspect has not been considered in the document. The paper is very general and assumes, without providing any detailed analysis, that one acute hospital based in either Enniskillen or Omagh is capable of serving the needs of the people in the south-western area.
This assumption was not borne out by a review of acute hospital services in the Sperrin Lakeland Trust carried out in 1996. The review was commissioned jointly by the trust and the three councils in the area — Strabane, Omagh and Fermanagh. It explored the options and recommended a strategy for hospital provision in the west — namely, that one hospital on two sites (Omagh and Enniskillen) was the best basis for the development of acute services.
This document has ignored that review and the combined views of the three councils, Omagh, Fermanagh and Strabane, which serve Counties Fermanagh and Tyrone. Instead of setting out an appropriate response for delivering important medical services to rural areas, it recommends a solution more befitting an urban problem.
In the document there is much reference to the provision of a modernised and highly effective ambulance service. The Minister said today that this service was "the key to unlocking the way forward". The reality is that Fermanagh has the worst roads infrastructure in Ireland. The main road between Omagh and Enniskillen is in very poor condition and deteriorating. It is impossible to achieve improvement in ambulance response times.
The paper refers to improvement in the service provided by GPs. In April 1998 the GPs in Fermanagh set up an out-of-hours co-operative. The centre is in Enniskillen and claims to provide a service for the entire county. There are grave concerns among the people of Fermanagh about that arrangement. Already a number of incidents are under investigation. In some cases it can take 45minutes — in others it can take longer — to reach a patient in an emergency.
The paper draws attention to the important issues of efficiency, effectiveness, standards, recruitment and training, but the primary issue is accessibility. Common sense tells us that state-of-the-art services which are not accessible when required are useless. In a medical emergency time is all important. This is overlooked in the document. We must find a solution which addresses the needs of the people in Fermanagh and in west and south Tyrone.

Mr David Hilditch: I welcome the Minister. I have listened to submissions by my Colleagues MrHutchinson and MrBoyd on Whiteabbey Hospital. What assurances can the Minister give to the people of east Antrim, particularly the large rural community and those isolated in areas such as Islandmagee, Ballycarry and the north of Larne, regarding the standard, in the future, of the accident and emergency services? Response times are sometimes up to 45 minutes, and there is no minor injury unit in Larne.
The area is not without a history of serious incidents. My Colleague MrDodds and I share these concerns, having been involved in a tragic bus crash in the area some years ago when five lives were lost. Fortunately, Whiteabbey Hospital saved many more lives that evening. Does the Minister agree that as four hospitals in our constituency have been lost, there is a need to upgrade and improve the accident and emergency services and the cardiac unit at our only remaining facility? Since we have a strategic position in relation to the seaport and the flight paths of both airports, any review must take account of those services. Extra miles cost lives.

Ms Sue Ramsey: I welcome MrMcFall. In his opening remarks in the document he says
"This paper is not a blueprint for change. It is an analysis of where we are and a vision of what needs to be done".
I suggest that any proposals for change in the Health Service are checked against equality issues, and that there must be an appraisal to ensure that they do not limit access or discriminate against a section of the community on the basis of location and membership of disadvantaged groups. I recommend that a policy appraisal and fair treatment exercise be conducted.
I ask MrMcFall to tell us how bad the crisis in the Department of Health and Social Services is.

Mrs Eileen Bell: I shall be brief, as I am sure the Minister is suffering from speech fatigue. The Minister has listened to concerns in respect of every part of the Province. I commend him for Bangor Community Hospital. As a member of the council’s health committee, I had experience of the old hospital, which should not have been closed, and of the new hospital which is now in a beautiful centre and which I hope will continue to expand and develop.
The document reads more like an impossible dream than a realistic vision. If the Minister’s strategic vision that patients receive the right treatment at the right place from the right person is to be realised, we will need a lot of resources. Those resources must be guaranteed if we are to implement the proposals in the document and provide a health service for all of the people of NorthernIreland.
The document is a good base for good practice needs. However, successive Governments have found it impossible to address some of the problems in the Health Service, most of which have been caused by lack of resources. Health Service staff are very good, and proper tribute has been paid to them. However, resources are needed to put matters right, and the Minister will have to help us with money.

John McFall: If MrWells would like a chauffeur-driven car he can have mine. I come with gifts at Christmas and they are refused.
I thank the Assembly for the manner in which the debate has been conducted. I am indebted to Members for their constructive approach, and I am privileged to be discussing this issue with them.
After only one week in this job I was on duty in Omagh, and was privileged to witness the heroic work following the bomb there. What struck me was the fact that the whole of the National Health Service is greater than the sum of its parts. That led me to look at the Health Service in NorthernIreland as a whole — not disparately. Community and local issues are important, but it is also important to look at the whole picture. When I discovered that it had been 40years since the last comprehensive review of the Health Service, I resolved to publish this document so that the debate could take place.
People think that hospital services in NorthernIreland are fine, but they are not. I was asked about the developing crisis in the Health Service, which has been allayed by good work at local level. However, if the trend continues people will have a second-class service, and that cannot be tolerated.
The document has been generally accepted although in some cases parochialism was evident. The document challenges people by saying that a strategic view is needed.
First, I will respond to MrFoster’s comments about the golden six. This is a very unfortunate term that has been allowed to enter the lexicon of politics in NorthernIreland, and I do not know where it came from. What we should be talking about, rather than a golden six, is a golden network, an entire network that makes appropriate provision for the Health Service. That is why I have fashioned this document to incorporate the new care networks.
There should be four levels of care in a modern NHS. First, there is the primary care level, and why so? This is because over 90% of all consultations take place at primary care level. People go to GPs, nurses and community practitioners, and the service is provided there. Now, sensible policy dictates that if the resources are there, the money must also be targeted there, so that has to change.
DrMcDonnell asked whether this was a health service or a disease service. It is a health service, and we need to make sure that we have preventative health provision at community level, and community care teams are extremely important.
Secondly, the local hospitals should be the cornerstones, and ten local hospitals have been suggested. Some have asked whether they are just going to be super clinics with GPs in attendance. The present models in Ards and Bangor, where GPs have developed their resources, should be looked at. I went to visit one of the GPs in charge, DrIanClements, and asked him how long it takes people to start thinking about change and to get it going? He said that there had to be elements of remuneration and that aspects such as clinical development had to be taken care of, but that it took five or six years. Then I asked if he would change it, and he said absolutely not, because they had a service that provided patients with a local accident unit which did not abuse accident-and-emergency provisions.
People ask why I am thinking of change when we have accident-and-emergency services now and people can go and queue for four hours at a hospital. The reason is that three out of every four people who attend accident-and-emergency units should not be there — they go with minor injuries. There is a statutory requirement in accident-and-emergency units for people to be seen; that is why there are four-hour queues. Resources are not properly used in our accident-and-emergency services. That is the issue at stake here.
DrHendron mentioned the need to establish a Shadow Executive. I am not going into the politics now; I am remaining with health. However, I say to Members today that I am willing to ensure that we have dialogue with the Assembly health spokespersons so that, when the Assembly is established, Members will have the information.
I am not here for the next few months to hoard information and then to hand it out in dribs and drabs. I want to engage with the Assembly fully on this so that Members will be able to take those decisions from a very early stage — that offer is open. I hope that, along with both the First and the Deputy First Ministers (Designate), we can explore ideas, but the Assembly can come back to me any time on that issue.
I will quickly address the matter raised by DrHendron about the Mater Hospital. The trustees have plans to replace the existing ward accommodation using trust funds, and no commitment to using public funds has been given. However, a fully worked out business case will be required if public funds are sought, and decisions on the business case will reflect the strategic agenda and be influenced by the outcome of a review undertaken by the Eastern Health Board.
I mentioned primary care, and I described the 10local hospitals as being the corner stone. One important aspect of this is that the local hospital, the area hospital and the two regional hospitals will form a network.
The Royal College has stated that acute services should be based on a population of 450,000. My own constituency has moved to that figure. It is not easy. When people are well they want to have a hospital near them, but when they are ill they want to have the best service and will travel to get it. Surveys in Northern Ireland have reflected this.
It is not possible for NorthernIreland to have three acute hospitals because of its geography and its rural element. So I have suggested four area hospitals, with three others being enhanced. Those will be allied to the two regional hospitals which at the moment are performing cleft palate, and cochlear implant operations that would not normally be provided for a population of one and a half million.
I am suggesting that there is interlinking between the hospitals and centralisation, but there is also decentralisation. We can see that with the Campbell Report on cancer care where operations are being decentralised to the local level.
MrGibson mentioned the 40-year-old patient in Muckamore Abbey. I have a letter copied from MrsHilarySmith, and I will certainly get back to him on that issue.
MrMolloy said that in the past people have been told about what they were losing, not about what they were getting. I would like to consider this document as an audit — the books are open. Members will have to decide for themselves. Members can challenge it if they wish, and it is there to be challenged, but I believe that Members will find it very difficult to challenge its analysis. But if Members decide differently, I will be quite happy to look at it again.
MrMolloy also asked about the provision for clinical governance at the moment. Quality is the major priority, and clinical governance is there to ensure that the proper processes and systems are in place at each hospital, those that will ensure that the best quality of care is delivered. No matter where one lives in Northern Ireland, one can be assured of the same level of service.
MrClose focused solely on the Lagan Valley Hospital. He mentioned that he had fought the Tories and that he was going to fight others. Well, best wishes to him, because he will shortly have to fight with his fellow Assembly Members. But that will be for him to decide.
As far as I know, Lagan Valley is about 20minutes from Belfast by road. I was reading my ‘West Highland Free Press’ at the weekend, and in it was a plea from a GP on the Isle of Skye. He said that there was going to be a consultancy and that the area’s constituents would have to travel for three hours. So NorthernIreland is doing quite well, particularly the Lagan Valley Hospital.
Maternity services were mentioned, and I have a personal tale to tell. I do not want to see any child born in a maternity unit which does not have back-up paediatrics and anesthetists. My wife and I lost our second child, who was still-born, and my wife was taken into hospital early with our fifth child because she had placenta previa. Notwithstanding that, on the day of the birth she took a haemorrhage and had to be taken to the emergency operating theatre. The doctors had predicted that everything would be okay but that proved not to be the case. Nobody can predict with absolute certainty that everything will be okay, and that is why we need back-up paediatrics and anesthetists. I see that as being extremely important.
Maternity services have been getting on well because of the dedication of the staff, as Donaldson said in his review. We should not impose these problems on staff; and change is needed in these areas.
I do not accept AssemblymanBoyd’s assertion that "centres of excellence" is just a fancy name for cost-cutting. He asked me not to take any decisions until Members can decide for themselves. I have to say, clearly and unambiguously, that I will not give a positive response to that. Very serious issues are frequently landing on my desk, so I am going to discharge my responsibility as a Minister with the integrity that the post demands. I will try to preserve quality and safety in the Health Service in NorthernIreland but I look forward to the Assembly taking up these particular issues.
Ms McWilliams encapsulated Members’ feelings when she said that they wanted something done, but not in their area. She mentioned community care. In the allocations announced today we have given £25million to community care. At a dinner several months ago the directors of community care said to me that their area was the Cinderella of the Health Service and that the Government should focus attention on it.
Government is about priorities. If we focus too much on hospitals, then we let down community care. There are priorities and balances to be maintained. MsMcWilliams got it right when she citied her sister’s crash two years ago. She said that her sister got the best service in the regional hospital, the Royal Victoria Hospital, where the orthopaedic services were available. That was also the case in Omagh. Triage was carried out after the bombing, and people were sent to the best places for their injuries — to Altnagelvin for limbs or to the Royal Victoria Hospital for neurosurgery, or whatever. We can provide at a local level, but when expert service is required, the Government must ensure that an appropriate network exists. That is extremely important.
Assemblyman McGimpsey asked why the Jubilee maternity unit is to be closed. This decision is the subject of an application to judicial review, and it would be inappropriate for me to comment on it at this time. However, I will look at this matter with my officials and forward a reply.
AssemblymanMcGrady and I have been discussing Downe Hospital since the day I came to NorthernIreland. I remember being in my car the first day I was here, and the mobile phone rang. It was the ‘Down Recorder’, and ever since then I have had an affiliation with AssemblymanWells and Assemblyman McGrady. There is an urgent need to replace the existing Downe Hospital, and I think that we would agree on that.
I have set a challenging timetable for the production of a new business case for the hospital. It has to be produced by March and once this is approved I want the project to go ahead as quickly as possible. The necessary funding will be found from the overall comprehensive spending review settlement that I announced today. I welcome the support for a quick completion of the business case shown by AssemblymanMcGrady last week in his comments to the press.
Assemblyman Shannon mentioned the possibility of outstations at Ballywater and Kircubbin. I will look at this issue with my officials to see exactly what can be done in that area.
Assemblyman McGuinness said that the debate on the Health Service has been driven by the Government, by the Royal Colleges and by the boards. I want the debate to be influenced by the community, hence the ‘Putting it Right’ paper. It is available for debate, it is available for consultation, and it is available to ensure that the Government listen to everyone’s voice. There has possibly been benign neglect over 40years, but there is urgency to this matter now. Assemblyman McGuinness said that there is something wrong when 20,000 to 30,000people turn out to demonstrate.
Yes, there is something wrong; there is a legacy of neglect. I do not want people to be frightened and anxious. It is therefore incumbent upon all of us to ensure that we do have a strategy. Not everyone is going to like it, but it is very important to have a strategy. AssemblymanHutchinson made a good comment recently:
"I think the Assembly is going to have to take hard decisions. I hope that people are not parochial about this and start fighting their own corner. We are all elected by different constituencies and, of course, when we get to hell, it is a question of leadership."
It is a question of leadership for all of us — for me as much as for anybody else. It would have been better for me not to tackle this issue over the last few months, not to wander into areas of political controversy and not to have AssemblymanHaughey and others phoning the radio about me, but that would have been a dereliction of duty. It is very important that leadership is shown by yourselves and by me so that we work together to ensure that when March comes, we are doing something about the issue.
AssemblymanHaughey mentioned the west of the Bann, an important aspect of which I was acutely aware. I have set up an ambulance review, and that is going to report next year. However, I was not content with just a review, because I had heard time and time again about the various problems, and that is why the document’s only explicit commitment is for £15million for the Ambulance Service.
People ask what is the use of the extra money for the Ambulance Service. It is very valuable and everybody has recognised that today. Northern Ireland shares with Scotland a high rate of coronary heart disease as a consequence of bad diet and unhealthy living. People have heart attacks in different parts of the country. If we get a good Ambulance Service, it will ensure that we get ambulances to the places where people are ill. We have quick response times, and we are trying to improve those times. Any medic will tell you that in a critical situation, the time after the attack is extremely important: the time when one attempts to stabilise the condition.
I envisage an ambulance system with improved technology and communications and with trained paramedics linked up by cellular telephone to consultant cardiologists so that expert advice can be given at the site of an incident. A person could be stabilised there and then and taken to hospital. This is my vision for the Ambulance Service, and it is crucial that we work together on it.
AssemblymanHaughey sees a conspiratorial element in the closure of the South Tyrone Hospital. MrKenMaginnis, the MP for the area, took the same conspiratorial approach to me in a debate last week in Parliament. I will be very clear on the matter. I am not going to go back on anything that the doctors, the anaesthetists or the consultants at the South Tyrone have said. As JohnMcFall, as Minister for Health, as a politician and a non-medic, I am not going to second-guess doctors when they talk to me about the safety of the service. I am very clear on that, and I will not go back on it.
AssemblymanMcCrea talks of people being smug. Nobody is being smug here today on any issue. He spoke about the quality of services and the quality of the accessibility, and I am 100% with him on that. It is said that I am making it comfortable for the Royal Colleges — people have made this point to me about the Royal Colleges. It is said that the Royal Colleges have the best closed shop in the land, the best trade union you can get and that everything is being done at their dictate. I do not accept any of this. We have to work alongside the Royal Colleges to establish the best training for doctors and the best quality of care. We have to take them in to our confidence.
I have been impressed with the comments that I have received from the Royal Colleges over the past few months, and I hope that the Assembly will work with the Royal Colleges to ensure that NorthernIreland gets adequate treatment. We have had horrendous cases in the United Kingdom, such as in Bristol, and we must ensure that the best training and quality are provided.
MrsNelis mentioned trust chief executives’ pay. I agree entirely on that point. I am not opposed to people being properly remunerated for their services, but in recent years chief executives’ pay has become distorted in relation to the pay of other Health Service staff.
I have written to the chief executives of trusts and boards asking for a breakdown of senior executives’ pay so that I can examine the issue and ensure that it remains within the stated guidelines. I am hoping to prepare a paper for the Assembly so that, if required, primary legislation can be introduced on the issue.
AssemblymanRHutchinson talked about East Antrim and asked me to check about two new ambulances in Larne. I will do that.
AssemblymanMcDonnell asked whether it was a disease service or a health service. The Government have produced a White Paper on smoking. He was somewhat conservative in his estimates — around 3,000people in NorthernIreland die each year from lung cancer. It is important to have a healthy-living strategy — a social agenda for health — and that can tie in with Government’s primary care vision.
AssemblymanMorrow mentioned an Information Technology structure. Telemedicine is the answer. Go, as I have done, to Ards or Bangor Hospitals and see the link up. I had a link up with a consultant in the Royal, but it could just as easily have been a consultant in Aberdeen or London. The examination takes place, information technology is used to best advantage — and this is important — the patient is treated at local level.
AssemblymanWells mentioned, in almost biblical terms, the challenge to the new Health Minister. Maybe I will hold a competition for that, and the Assembly could work on it with me.
AssemblymanGallagher mentioned accessibility in the west of the Province. That is at the core of this document, and I am happy to work with Members on that.
Finally, this vision is perhaps 30years too late, but the Health Service needs to be tackled radically now — the status quo is not an option. With the status quo, an extra 120consultants would need to be recruited. Fourteen per year are being trained, so it cannot be done. But even if it could, it would result in overstaffing, a loss of skills and the underutilisation of equipment. That is no recipe for a modern health service.
A modern health service should provide people with a service at the right level; we do not have that at present. According to the Royal Colleges, only four hospitals out of 17 satisfy surgical requirements, and on accident and emergency only six out of 17 satisfy those requirements. That is not good enough — change is needed.
This document is all about the right people, the right technology and equipment, and the right hospital buildings and facilities. It focuses on the patient, irrespective of where he lives in NorthernIreland, so that proper treatment and care can be given at the right time, in the right place, to the right person. I look forward in the next few months to working up this document with the Assembly and thank Members most sincerely for their courtesy this afternoon.

Lord Alderdice: On behalf of the Assembly, I should like to thank the Minister for his presentation, for listening so intently to Members, for undertaking to work closely with the Assembly in its shadow period, and for agreeing to make specific written replies to those Members whose questions he was unable to answer satisfactorily today. It is clear that Members appreciate this very much.
Question put and agreed to.
Resolved:
That this Assembly takes note of the report ‘Putting it Right — The Case for Change in NorthernIreland’s Hospital Service’, as presented by MrJohnMcFall MP, Minister for Health and Social Services.
The sitting was suspended at 6.01 pm.